Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | H4480 | TX |
NPI | 1780693911 |
---|---|
Provider Name | Dr. Robert M. Leath |
First Address | Houston, TX 77024-2301 |
Second Address | Houston, TX 77080 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2006 |
Last Update Date | 11/04/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E03388 | (02) | TX |
H4480 | MEDICAL LICENSE (01) | TX |