Provider Demographics
NPI:1992762280
Name:BRILL, LEON R (DPM)
Entity type:Individual
Prefix:DR
First Name:LEON
Middle Name:R
Last Name:BRILL
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 1:5481 BLAIR RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4101
Mailing Address - Country:US
Mailing Address - Phone:214-369-7400
Mailing Address - Fax:214-369-7408
Practice Address - Street 1:5481 BLAIR RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4101
Practice Address - Country:US
Practice Address - Phone:214-369-7400
Practice Address - Fax:214-369-7408
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0628213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0628OtherPODITRY
TX0628OtherPODITRY
TXT12374Medicare UPIN