Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | N0207 | TX |
NPI | 1013014570 |
---|---|
Provider Name | Ben A Leeson |
First Address | Corpus Christi, TX 78405-1804 |
Second Address | Corpus Christi, TX 78405-1833 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2006 |
Last Update Date | 18/06/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
937576 | (05) | AZ |
I29445 | (02) |