MEDICARE: DR. LEEN AL-HAFEZ 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
1	207V00000X	Obstetrics & Gynecology Physician	BP10053941	TX
2	207V00000X	Obstetrics & Gynecology Physician	T4306	TX

General Provider Information

NPI Number	:	1255702544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEEN AL-HAFEZ M.D

Provider Business Mailing Address
First Line	:	5323 HARRY HINES BLVD APT 18305
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75390-7201
Country	:	US
Telephone Number	:	214-590-2776
Fax Number	:	214-645-0078

Provider Business Practice Location Address
First Line	:	5200 HARRY HINES BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75390-2916
Country	:	US
Telephone Number	:	214-590-2776
Fax Number	:	214-645-0078

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

Provider Enumeration Date	:	10/12/2015
Last Update Date	:	08/11/2022

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