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General NPI Number Information
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NPI Number | 1760428361
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Entity Type | Organization
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Legal Business Name | SUNDANCE ANESTHESIA PA
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Dates
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Enumeration Date | 06/21/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6100 HARRIS PKWY
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City | FORT WORTH
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State | TX
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Zip | 76132-4101
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Country | US
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Telephone | 817-433-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 4200 S HULEN ST SUITE 425
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City | FORT WORTH
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State | TX
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Zip | 76109-4908
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Country | US
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Telephone | 817-731-2875
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Fax | 817-731-6165
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERT BRUCE LEITCH
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Credential | MD
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Telephone | 817-731-2875
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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 |
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License Number State |
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