Provider Demographics
NPI:1003975525
Name:LEBOVIC, GAIL S (MD)
Entity Type:Individual
Prefix:DR
First Name:GAIL
Middle Name:S
Last Name:LEBOVIC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12200 PRESTON RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-2223
Mailing Address - Country:US
Mailing Address - Phone:972-560-2667
Mailing Address - Fax:
Practice Address - Street 1:12200 PRESTON RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2223
Practice Address - Country:US
Practice Address - Phone:972-560-2667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM01452086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8M5535OtherBLUE CROSS
TX8M5535OtherBLUE CROSS
TXF25520Medicare UPIN