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NPI Code Detail

MEDICARE: MARK ELLIOTT LECLAIR NP

MEDICARE: MARK ELLIOTT LECLAIR NP
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
1363LP0200XPediatric Nurse PractitionerAP135354TX

General Provider Information

NPI Number : 1174017099
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK ELLIOTT LECLAIR NP
Provider Business Mailing Address
First Line : 7209 STONETRAIL DR
Second Line :
City : DALLAS
State : TX
Zip : 75230-5404
Country : US
Telephone Number : 469-387-3305
Fax Number :
Provider Business Practice Location Address
First Line : 1935 MEDICAL DISTRICT DR
Second Line :
City : DALLAS
State : TX
Zip : 75235-7701
Country : US
Telephone Number : 214-456-7000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/15/2018
Last Update Date : 06/15/2018

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