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General NPI Number Information
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NPI Number | 1508822263
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Entity Type | Individual
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Provider Name | BRADLEY D. LEATHERWOOD M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/21/2006
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Last Update Date | 07/02/2012
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Provider Practice Location Address
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Address Line | 1022 E 6TH 1/2 ST
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City | HOUSTON
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State | TX
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Zip | 77009-7328
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Country | US
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Telephone | 713-614-3172
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Fax | 281-888-5754
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Provider Business Mailing Address
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Address Line | 1022 E 6TH 1/2 ST
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City | HOUSTON
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State | TX
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Zip | 77009-7328
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Country | US
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Telephone | 713-614-3172
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Fax | 281-888-5754
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 46454
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | M3625
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License Number State | TX
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