Healthcare Provider Details

I. General information

NPI: 1275797243
Provider Name (Legal Business Name): BRIAN JOHN LEYKUM DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2008
Last Update Date: 01/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6448 E HWY 290 SUITE # D-103
AUSTIN TX
78723-1068
US

IV. Provider business mailing address

6448 E HWY 290 SUITE # D-103
AUSTIN TX
78723-1068
US

V. Phone/Fax

Practice location:
  • Phone: 512-452-2100
  • Fax: 512-452-2106
Mailing address:
  • Phone: 512-452-2100
  • Fax: 512-452-2106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number1994543
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number2045
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: