=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790083111
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LEON R. BRILL, D.P.M., F.A.C.F.A.S., P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/09/2011
-----------------------------------------------------
Last Update Date | 03/09/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5481 BLAIR RD
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75231-4101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-369-7400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5481 BLAIR RD
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75231-4101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-369-7400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | LEON R BRILL
-----------------------------------------------------
Credential | D.P.M.
-----------------------------------------------------
Telephone | 214-369-7400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | 0628
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------