Individual
MR. RAYMOND B LEIDICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2134 N KANSAS AVE, LIBERAL, KS 67901-2012
(620) 624-1500
(620) 624-1501
Mailing address
2134 N KANSAS AVE, LIBERAL, KS 67901-2012
(209) 339-9036
(209) 339-1901
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
04-30944
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100024200A
—
OK
05
—
200335440A
—
KS
Enumeration date
02/03/2006
Last updated
10/13/2016
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