Provider Demographics
NPI:1306968748
Name:TIMOTHY A. LEACH MD INC
Entity type:Organization
Organization Name:TIMOTHY A. LEACH MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:LEACH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-935-6952
Mailing Address - Street 1:110 TAMPICO STE 210
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-2962
Mailing Address - Country:US
Mailing Address - Phone:925-935-6952
Mailing Address - Fax:925-935-1396
Practice Address - Street 1:110 TAMPICO STE 210
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2962
Practice Address - Country:US
Practice Address - Phone:925-935-6952
Practice Address - Fax:925-935-1396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-05
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG81727174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherTAX ID