Individual
JACK DELEONARDO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
650 E INDIAN SCHOOL RD, DEPT VETERANS AFFAIRS, PHOENIX, AZ 85012
(602) 277-5551
Mailing address
2699 S 167TH DR, GOODYEAR, AZ 85338-7317
(406) 927-2221
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
196
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0433296
MDCD PIN
MT
01
—
092303
BCBS PIN
MT
01
—
12355900
MDCD PIN
WY
Enumeration date
08/31/2006
Last updated
11/02/2016
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