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General NPI Number Information
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NPI Number | 1679867295
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Entity Type | Individual
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Provider Name | THOMAS EDISON LEARY JR. FNP
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Gender | Male
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Dates
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Enumeration Date | 05/31/2011
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Last Update Date | 06/09/2021
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Provider Practice Location Address
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Address Line | 3910 GASTON AVE STE 140
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City | DALLAS
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State | TX
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Zip | 75246-1523
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Country | US
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Telephone | 214-494-8121
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Fax |
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Provider Business Mailing Address
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Address Line | 6145 N 18TH AVE
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City | PHOENIX
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State | AZ
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Zip | 85015-2053
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Country | US
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Telephone | 214-701-7908
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP8332
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License Number State | AZ
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