Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | 20098 | NV |
N | 207RC0000X | Internist - Cardiovascular Disease | A106468 | CA |
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | 20098 | NV |
N | 207RC0001X | Clinical Cardiac Electrophysiologist | A106468 | CA |
NPI | 1205864865 |
---|---|
Provider Name | Joshua G Leichman |
First Address | Las Vegas, NV 89193-8978 |
Second Address | Henderson, NV 89052-4171 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2006 |
Last Update Date | 11/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1205864865 | (05) | CA |