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General NPI Number Information
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NPI Number | 1497767420
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Entity Type | Individual
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Provider Name | THOMAS MICHAEL LEATH M. D.
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Gender | Male
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Dates
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Enumeration Date | 08/11/2006
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Last Update Date | 10/31/2023
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Provider Practice Location Address
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Address Line | 3410 FAR WEST BLVD SUITE 146
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City | AUSTIN
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State | TX
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Zip | 78731-3194
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Country | US
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Telephone | 512-349-0777
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Fax | 512-349-9111
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Provider Business Mailing Address
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Address Line | PO BOX 603725
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City | CHARLOTTE
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State | NC
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Zip | 28260-3725
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Country | US
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Telephone | 828-575-2625
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Fax | 828-350-2174
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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 | 2080P0201X
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Taxonomy Name | Pediatric Allergy/Immunology Physician
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License Number | M4273
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | M4273
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 207KA0200X
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Taxonomy Name | Allergy Physician
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License Number | M4273
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License Number State | TX
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