Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 33571 | MN |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 33571 | MN |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 33571 | MN |
NPI | 1023279197 |
---|---|
Provider Name | Dr. Mark Leenay |
First Address | Princeton, MN 55371-5007 |
Second Address | Princeton, MN 55371-5007 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2008 |
Last Update Date | 22/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E22107 | (02) | MN |