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General NPI Number Information
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NPI Number | 1073746160
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Entity Type | Individual
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Provider Name | LEESA BLAKE CONDRY M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/24/2009
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Last Update Date | 08/24/2009
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Provider Practice Location Address
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Address Line | 3605 LEXINGTON AVE
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City | DALLAS
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State | TX
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Zip | 75205-3916
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Country | US
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Telephone | 214-526-7995
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Fax | 214-522-1460
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Provider Business Mailing Address
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Address Line | 3605 LEXINGTON AVE
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City | DALLAS
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State | TX
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Zip | 75205-3916
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Country | US
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Telephone | 214-526-7995
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Fax | 214-522-1460
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | E9043
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License Number State | TX
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