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NPI Code Detail

MEDICARE: DR. LEESA BLAKE CONDRY M.D.

MEDICARE:  DR. LEESA BLAKE CONDRY  M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207VG0400XGynecology PhysicianE9043TX

General Provider Information

NPI Number : 1073746160
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LEESA BLAKE CONDRY M.D.
Provider Business Mailing Address
First Line : 3605 LEXINGTON AVE
Second Line :
City : DALLAS
State : TX
Zip : 75205-3916
Country : US
Telephone Number : 214-526-7995
Fax Number : 214-522-1460
Provider Business Practice Location Address
First Line : 3605 LEXINGTON AVE
Second Line :
City : DALLAS
State : TX
Zip : 75205-3916
Country : US
Telephone Number : 214-526-7995
Fax Number : 214-522-1460
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/24/2009
Last Update Date : 08/24/2009

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Directions to “ DR. LEESA BLAKE CONDRY M.D.” Practice Location

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