Individual
DR. JACK J. LEONARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
122 W 7TH AVE, STE 110, SPOKANE, WA 99204-2349
(509) 456-0262
(509) 462-5059
Mailing address
122 W 7TH AVE, STE 110, SPOKANE, WA 99204-2349
(509) 456-0262
(509) 462-5059
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
M-8957
ID
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
MD00018141
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004173400
—
ID
01
—
11107621
MEDICARE PTAN
ID
05
—
1599901
—
WA
01
—
G8871041
MEDICARE PTAN
WA
01
—
G8878300
MEDICARE PTAN
WA
Enumeration date
07/13/2005
Last updated
01/12/2012
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