Individual
MR. ERIC B LEACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1055 N 500 W, SUITE 121, PROVO, UT 84604-3305
(801) 373-7350
Mailing address
1055 N 500 W, CREDENTIALING DEPARTMENT, PROVO, UT 84604-3305
(800) 135-4822
(801) 429-8150
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2533
AZ
363AS0400X
Surgical Physician Assistant
8533
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
867525
—
AZ
Enumeration date
06/08/2006
Last updated
11/18/2021
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