Healthcare Provider Details

I. General information

NPI: 1841292299
Provider Name (Legal Business Name): THOMAS LEACH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 ROCKMEAD DR 600
KINGWOOD TX
77339-2258
US

IV. Provider business mailing address

PO BOX 841969
DALLAS TX
75284-1969
US

V. Phone/Fax

Practice location:
  • Phone: 281-348-7575
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberE1015
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: