Individual
JASON E LEEDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2060 LANDER RD, MAYFIELD HEIGHTS, OH 44124-4100
(440) 461-6100
(440) 461-1440
Mailing address
PO BOX 660, MENTOR, OH 44061-0660
(440) 854-0217
(440) 461-1440
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
35085266
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000376503
ANTHEM BLUE SHIELD
OH
05
—
2598916
—
OH
01
—
R85266
SUMMACARE
OH
Enumeration date
10/04/2006
Last updated
06/04/2024
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