Healthcare Provider Details

I. General information

NPI: 1023320017
Provider Name (Legal Business Name): LEISA MARIE DEUTSCH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2010
Last Update Date: 05/21/2021
Certification Date: 05/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13000 SPACE CENTER BLVD
HOUSTON TX
77059-4724
US

IV. Provider business mailing address

2921 SEA CHANNEL DR
SEABROOK TX
77586-1641
US

V. Phone/Fax

Practice location:
  • Phone: 941-376-8219
  • Fax:
Mailing address:
  • Phone: 941-376-8219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0101254235
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberS1078
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: