Individual
FRED J. LEITZ III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5814 GRAHAM AVE, SUITE 100, SUMNER, WA 98390-2728
(253) 863-4474
(253) 863-4062
Mailing address
5814 GRAHAM AVE, SUITE 100, SUMNER, WA 98390-2728
(253) 863-4474
(253) 863-4062
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD00015420
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1215102
—
WA
01
—
20598
DEPT. OF LABOR & IND.
WA
Enumeration date
09/01/2006
Last updated
01/08/2008
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