Healthcare Provider Details

I. General information

NPI: 1992762280
Provider Name (Legal Business Name): LEON R BRILL DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 02/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5481 BLAIR RD
DALLAS TX
75231-4101
US

IV. Provider business mailing address

5481 BLAIR RD
DALLAS TX
75231-4101
US

V. Phone/Fax

Practice location:
  • Phone: 214-369-7400
  • Fax: 214-369-7408
Mailing address:
  • Phone: 214-369-7400
  • Fax: 214-369-7408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number0628
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: