Individual
JAMES C LEAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
434 N CAPTAIN GLOSTER DR, GLOSTER, MS 39638-3401
(601) 225-4711
Mailing address
PO BOX 639, CENTREVILLE, MS 39631-0639
(601) 645-5221
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
12264
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00018128
—
MS
05
—
1391875
—
LA
Enumeration date
06/28/2006
Last updated
01/19/2010
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