Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | M4273 | TX |
N | 2080P0201X | Pediatric Allergist | M4273 | TX |
NPI | 1497767420 |
---|---|
Provider Name | Thomas Michael Leath |
First Address | Austin, TX 78731-3194 |
Second Address | Austin, TX 78731-3194 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2006 |
Last Update Date | 04/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H89924 | (02) |