Individual
DR. LAWRENCE A. LEAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2809 DENNY AVE, PASCAGOULA, MS 39581-5301
(228) 809-5000
Mailing address
2101 HIGHWAY 90, GAUTIER, MS 39553-5340
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
MS13594
MS
207Q00000X
Family Medicine Physician
Primary
13594
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00112590
—
MS
05
—
009926475
—
AL
01
—
646000515
TRICARE
—
01
—
930026898
RAILROAD MEDICARE
—
Enumeration date
01/12/2007
Last updated
01/11/2021
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