Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | S2387 | TX |
NPI | 1780029504 |
---|---|
Provider Name | Peter Jospeh Leahy |
First Address | Dallas, TX 75373-3784 |
Second Address | Fort Worth, TX 76104-2500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2013 |
Last Update Date | 13/04/2021 |