Provider Demographics
NPI:1699132589
Name:PETER D LEONARD, M.D. PA
Entity type:Organization
Organization Name:PETER D LEONARD, M.D. PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:D
Authorized Official - Last Name:LEONARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-919-4635
Mailing Address - Street 1:1400 W 7TH ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76102-2625
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6957 W PLANO PKWY
Practice Address - Street 2:SUITE 2300
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-1620
Practice Address - Country:US
Practice Address - Phone:214-919-4635
Practice Address - Fax:214-919-4639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-22
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF6873174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C18331Medicare UPIN