Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | 35061662 | OH |
NPI | 1265468383 |
---|---|
Provider Name | Dr. Jonathan F Leake |
First Address | Sandusky, OH 44871-0378 |
Second Address | Sandusky, OH 44870-5390 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2006 |
Last Update Date | 22/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0837723 | (05) | OH |
E42039 | (02) | OH |