Individual
MARK JONATHON LEACH
Active
Individual
MARK JONATHON LEACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
PA9101548
FL
363AM0700X
Medical Physician Assistant
Primary
PA9101548
FL
Other
Enumeration date
05/24/2006
Last updated
08/22/2022
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