Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | ME44750 | FL |
N | 207QA0401X | Family Doctor - Addiction Medicine | ME 0044750 | FL |
NPI | 1003091372 |
---|---|
Provider Name | Dr. William C Leach |
First Address | Ocala, FL 34478-4590 |
Second Address | Ocala, FL 34471-0441 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/01/2008 |
Last Update Date | 24/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000216900 | (05) | FL |