Individual
DR. JEFFREY LOUIS LEABERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ANESTHESIOLOGIST
Contact information
Practice address
2900 FIRST AVENUE, HUNTINGTON, WV 25702
(304) 526-1031
Mailing address
PO BOX 515, BARBOURSVILLE, WV 25504-0515
(304) 736-6126
(304) 736-1531
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
17790
WV
207L00000X
Anesthesiology Physician
Primary
35.080552
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001721141
WV BLUE CROSS PROVIDER #
WV
05
—
0060808000
—
WV
01
—
440585258-00
WV WORKERS COMP PROVIDER
WV
Enumeration date
11/09/2006
Last updated
03/29/2018
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