Most Relevant Information
Provider Data
| NPI Number: | 1003312067 |
| Provider Name: | JACOB LEEDEKERKEN |
| Entity Type: | Individual |
| Taxonomy Code: | 207P00000X |
| Specialty: | Emergency Medicine |
| License Number: | 238485 |
Most Important Dates
| Enumeration Date: | 03/30/2018 |
| Last Updated: | 04/03/2018 |
Provider Practice Location
1000 BLYTHE BLVD
CHARLOTTE
NC
282035812
Practice Location Phone/Fax
| Phone: | 7043553181 |
| Fax: |
Provider Mailing Location
813 12TH ST NE
WASHINGTON
DC
200024435
Provider Mailing Phone/Fax
| Phone: | 7705989580 |
| Fax: |