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General NPI Number Information
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NPI Number | 1013727155
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Entity Type | Organization
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Legal Business Name | LEAFWELL PROVIDERS, P.A.
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Dates
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Enumeration Date | 01/10/2025
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Last Update Date | 01/10/2025
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Provider Practice Location Address
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Address Line | 111 WESTLAKE DR
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City | WEST LAKE HILLS
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State | TX
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Zip | 78746-5301
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Country | US
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Telephone | 504-458-4481
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Fax |
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Provider Business Mailing Address
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Address Line | 3300 BEE CAVES RD STE 6501105
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City | WEST LAKE HILLS
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State | TX
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Zip | 78746-6600
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Country | US
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Telephone | 800-660-9085
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | GAVIN MORELAND
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Credential | MD
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Telephone | 504-458-4481
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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