Healthcare Provider Details

I. General information

NPI: 1255330940
Provider Name (Legal Business Name): BENJAMIN J LEEAH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9601 SPUR 591 WILLIAM P. CLEMENTS, JR. UNIT
AMARILLO TX
79107-9606
US

IV. Provider business mailing address

9601 SPUR 591 WILLIAM P. CLEMENTS, JR. UNIT
AMARILLO TX
79107-9606
US

V. Phone/Fax

Practice location:
  • Phone: 806-381-7080
  • Fax: 806-381-0417
Mailing address:
  • Phone: 806-381-7080
  • Fax: 806-381-0417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberL5020
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: