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General NPI Number Information
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NPI Number | 1558528323
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Entity Type | Organization
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Legal Business Name | THOMAS J LECKMAN
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Dates
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Enumeration Date | 05/20/2008
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Last Update Date | 05/20/2008
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Provider Practice Location Address
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Address Line | 505 NW SHERIDAN RD SUITE C
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City | LAWTON
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State | OK
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Zip | 73505-6522
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Country | US
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Telephone | 580-248-7502
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Fax | 580-248-5003
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Provider Business Mailing Address
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Address Line | 505 NW SHERIDAN RD SUITE C
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City | LAWTON
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State | OK
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Zip | 73505-6522
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Country | US
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Telephone | 580-248-7502
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Fax | 580-248-5003
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. THOMAS JAY LECKMAN
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Credential | MD
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Telephone | 580-248-7502
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 10781
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License Number State | OK
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