Individual
JEFFREY DALE LEITNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
11209 N TATUM BLVD STE 175, STONECREEK MEDICAL ASSOCIATES, PHOENIX, AZ 85028-6016
(602) 652-8900
(602) 652-8909
Mailing address
11209 N TATUM BLVD STE 175, STONECREEK MEDICAL ASSOCIATES, PHOENIX, AZ 85028-6016
(602) 652-8900
(602) 652-8909
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
81048
AZ
207QA0505X
Adult Medicine Physician
42839
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
81048
TRAINING PERMIT
AZ
Enumeration date
01/11/2008
Last updated
07/27/2010
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