Provider Demographics
NPI:1982753786
Name:LEANZ, GARY FRANCIS (MD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:FRANCIS
Last Name:LEANZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1175
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-1175
Mailing Address - Country:US
Mailing Address - Phone:614-436-2639
Mailing Address - Fax:
Practice Address - Street 1:396 SHALE RIDGE CT
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-7919
Practice Address - Country:US
Practice Address - Phone:614-436-2639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35071499208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice