MEDICARE: BRIAN D LE MD

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
1	207RC0000X	Cardiovascular Disease Physician	K7789	TX
2	207RC0001X	Clinical Cardiac Electrophysiology Physician	K7789	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10590662	OTHER	TX	CAQH

General Provider Information

NPI Number	:	1235138306
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN D LE MD

Provider Business Mailing Address
First Line	:	8230 WALNUT HILL LN STE 410
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-4469
Country	:	US
Telephone Number	:	214-369-3613
Fax Number	:

Provider Business Practice Location Address
First Line	:	8230 WALNUT HILL LN STE 410
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-4469
Country	:	US
Telephone Number	:	214-369-3613
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	11/03/2020

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Directions to “ BRIAN D LE MD” Practice Location

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