Provider Demographics
NPI:1316965239
Name:READ, LECK (MD)
Entity type:Individual
Prefix:
First Name:LECK
Middle Name:
Last Name:READ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:PARKPOOM
Other - Middle Name:
Other - Last Name:ROOTJANAPUNT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:888 S HILL RD
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-8400
Mailing Address - Country:US
Mailing Address - Phone:888-515-3500
Mailing Address - Fax:
Practice Address - Street 1:888 S HILL RD
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-8400
Practice Address - Country:US
Practice Address - Phone:888-515-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG146841207Q00000X
IA39334207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807920500Medicaid
F33593Medicare UPIN
ID807920500Medicaid