Provider Demographics
NPI:1104270024
Name:LEBER, JARED EDWARD (DPM)
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:EDWARD
Last Name:LEBER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3465 N ORCHARD
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85213-2090
Mailing Address - Country:US
Mailing Address - Phone:602-686-9594
Mailing Address - Fax:
Practice Address - Street 1:2855 E BROWN RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85213-4213
Practice Address - Country:US
Practice Address - Phone:602-345-0063
Practice Address - Fax:877-267-7965
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-17
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPOD000949213ES0103X
NV2049213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty