MEDICARE: DUSTIN RYAN LEEK 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	207LP2900X	Pain Medicine (Anesthesiology) Physician	R3129	TX
2	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	R3129	TX

General Provider Information

NPI Number	:	1902291362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DUSTIN RYAN LEEK MD

Provider Business Mailing Address
First Line	:	1006 LEGACY RANCH RD # 104
Second Line	:
City	:	WAXAHACHIE
State	:	TX
Zip	:	75165-1293
Country	:	US
Telephone Number	:	469-290-7246
Fax Number	:

Provider Business Practice Location Address
First Line	:	1006 LEGACY RANCH RD # 104
Second Line	:
City	:	WAXAHACHIE
State	:	TX
Zip	:	75165-1293
Country	:	US
Telephone Number	:	817-290-7246
Fax Number	:

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

Provider Enumeration Date	:	04/02/2015
Last Update Date	:	09/19/2025

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