Provider Demographics
NPI:1588795652
Name:LEEROY MCCURLEY MD PA
Entity type:Organization
Organization Name:LEEROY MCCURLEY MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEEROY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCURLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-266-5354
Mailing Address - Street 1:3121 S CARRIER PKWY
Mailing Address - Street 2:1
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-3734
Mailing Address - Country:US
Mailing Address - Phone:972-266-5354
Mailing Address - Fax:972-266-7878
Practice Address - Street 1:3121 S CARRIER PKWY
Practice Address - Street 2:1
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-3734
Practice Address - Country:US
Practice Address - Phone:972-266-5354
Practice Address - Fax:972-266-7878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH0618207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE20070Medicare UPIN
TX00910VMedicare UPIN