Basic Information
Provider Information
NPI: 1770506743
EntityType: 2
ReplacementNPI:  
OrganizationName: JASON E LEONARD, MD, PC
LastName:  
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Mailing Information
Address1: 3650 W ROCK CREEK RD
Address2: SUITE 100
City: NORMAN
State: OK
PostalCode: 730722202
CountryCode: US
TelephoneNumber: 4057013418
FaxNumber: 4057013451
Practice Location
Address1: 3650 W ROCK CREEK RD
Address2: SUITE 100
City: NORMAN
State: OK
PostalCode: 730722202
CountryCode: US
TelephoneNumber: 4057013418
FaxNumber: 4057013451
Other Information
ProviderEnumerationDate: 07/25/2006
LastUpdateDate: 04/06/2020
NPIDeactivationReasonCode:  
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AuthorizedOfficialLastName: LEONARD
AuthorizedOfficialFirstName: JASON
AuthorizedOfficialMiddleName: EDWARD
AuthorizedOfficialTitleorPosition: PRESIDENT
AuthorizedOfficialTelephone: 4057013418
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: DR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: M.D.
NPICertificationDate: 04/06/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000X20259OKY193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansAnesthesiology 

ID Information
IDTypeStateIssuerDescription
100149340A05OK MEDICAID


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