Individual
JOHN LEAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
2420 W PIERCE ST, STE 205, CARLSBAD, NM 88220-3543
(575) 887-0530
(575) 885-6309
Mailing address
612 N 13TH ST STE H, ARTESIA, NM 88210-1167
(575) 746-8880
(575) 746-2416
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
97-PA26
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00NM00RE62
BCBS
NM
05
—
37376781
—
NM
Enumeration date
08/23/2006
Last updated
07/04/2012
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