Individual
DR. HENRY THEODORE LEIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1720A MEDICAL PARK DR, SUITE 220, BILOXI, MS 39532-2129
(228) 392-9355
(228) 392-1781
Mailing address
6300 E LAKE BLVD, STE. 301, VANCLEAVE, MS 39565-6770
(228) 230-2663
(228) 206-1192
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
19613
MS
207XS0106X
Orthopaedic Hand Surgery Physician
19613
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06608789
—
MS
01
—
512I200015
MEDICARE PTAN
MS
Enumeration date
10/17/2005
Last updated
03/22/2017
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