Healthcare Provider Details

I. General information

NPI: 1467689604
Provider Name (Legal Business Name): STEVEN GARY LEEDS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2009
Last Update Date: 06/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3410 WORTH ST. SUITE 235
DALLAS TX
75246
US

IV. Provider business mailing address

3410 WORTH ST. SUITE 235
DALLAS TX
75246
US

V. Phone/Fax

Practice location:
  • Phone: 214-820-0434
  • Fax: 201-482-0043
Mailing address:
  • Phone: 214-820-0434
  • Fax: 214-820-0435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberP7942
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: