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Individual

WILLIAM A. LEESON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
454 ST MICHAELS DR, SANTA FE, NM 87505-7602
(505) 303-5000
Mailing address
PO BOX 26666, PROVIDER ENROLLMENT, ALBUQEURQUE, NM 87125-6666
(505) 923-6770
(505) 923-5354

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD2005-0499
NM

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
10024429
LOVELACE HEALTH PLAN
NM
05
37107704
NM
Enumeration date
04/20/2006
Last updated
03/19/2022
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