Individual
LAWRENCE J LEADER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 268-5800
(601) 261-3530
Mailing address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 296-3399
(601) 579-5240
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
14515
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00115279
—
MS
05
—
1779539
—
LA
01
—
640507572YR
AMERICAN ADMIN GROUP
MS
Enumeration date
08/18/2006
Last updated
07/20/2020
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