Provider Demographics
NPI:1275797243
Name:LEYKUM, BRIAN JOHN (DPM)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:JOHN
Last Name:LEYKUM
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6448 E HWY 290
Mailing Address - Street 2:SUITE # D-103
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-1068
Mailing Address - Country:US
Mailing Address - Phone:512-452-2100
Mailing Address - Fax:512-452-2106
Practice Address - Street 1:6448 E HWY 290
Practice Address - Street 2:SUITE # D-103
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723-1068
Practice Address - Country:US
Practice Address - Phone:512-452-2100
Practice Address - Fax:512-452-2106
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2014-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1994543213E00000X
TX2045213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX318479803Medicaid
TX318479802Medicaid
TXP01242878OtherRAILROAD MEDICARE
TX282321YUM7Medicare PIN
TXP01242878OtherRAILROAD MEDICARE