Organization
INDEPENDENT ANESTHESIOLOGISTS OF KITSAP CO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEFFREY PARK LEAKE MD (PRESIDENT)
(360) 479-0809
Entity
Organization
Contact information
Practice address
2025 WHEATON WAY, SUITE 102, BREMERTON, WA 98310-4300
(360) 479-0809
(360) 377-3577
Mailing address
2025 WHEATON WAY, SUITE 102, BREMERTON, WA 98310-4300
(360) 479-0809
(360) 377-3577
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
601433588
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
013194010
GROUP HEALTH COOPERATIVE
WA
01
—
038299
LABOR AND INDUSTRIES
WA
01
—
192575000
OWCP
WA
05
—
7077134
—
WA
Enumeration date
12/13/2006
Last updated
05/23/2008
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