Active NPI
Peter John Leeson III, D.O.
- Family Medicine Physician
- San Jose, CA
National Provider Identifier
1205985504
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 20A4223
- Practice address
- 1805 Cottle Ave
San Jose, CA 95125-3408 - Phone
- (408) 265-1118
- Fax
- (408) 265-7224
- NPI assigned
- Jan 9, 2007
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 20A4223 | CA | Primary |
Addresses
Primary practice location
1805 Cottle Ave
San Jose, CA 95125-3408
Mailing address
1805 Cottle Ave
San Jose, CA 95125-3408
Phone (408) 265-1118
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20A4223 | CA | MD | Family Medicine Physician |
| 4223 | CA | MD | Pediatric Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168300800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1205985504",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1805 COTTLE AVE",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951253408",
"telephone_number": "408-265-1118",
"fax_number": "408-265-7224"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1805 COTTLE AVE",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951253408",
"telephone_number": "408-265-1118",
"fax_number": "408-265-7224"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEESON",
"first_name": "PETER",
"middle_name": "JOHN",
"name_suffix": "III",
"credential": "D.O.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-09",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "CA",
"license": "20A4223",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Jose, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.