Provider Demographics
NPI:1104287887
Name:LEQUIRE, AMANDA (DO)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:
Last Name:LEQUIRE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:651 N HIGHWAY 183 STE 110
Mailing Address - Street 2:
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78641-7002
Mailing Address - Country:US
Mailing Address - Phone:512-528-0432
Mailing Address - Fax:512-528-0452
Practice Address - Street 1:651 N HIGHWAY 183 STE 110
Practice Address - Street 2:
Practice Address - City:LEANDER
Practice Address - State:TX
Practice Address - Zip Code:78641-7002
Practice Address - Country:US
Practice Address - Phone:512-528-0432
Practice Address - Fax:512-528-0452
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-09
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS1442207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine