Provider Demographics
NPI:1033447065
Name:ALAN C LESHNOWER MD, PA
Entity Type:Organization
Organization Name:ALAN C LESHNOWER MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:LESHNOWER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:432-332-6600
Mailing Address - Street 1:1220 W UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79764-7118
Mailing Address - Country:US
Mailing Address - Phone:432-332-6600
Mailing Address - Fax:866-673-0699
Practice Address - Street 1:1220 W UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79764-7118
Practice Address - Country:US
Practice Address - Phone:432-332-6600
Practice Address - Fax:866-730-6998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-02
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG0756208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG0756OtherMEDICAL LICENSE
TXG0756OtherMEDICAL LICENSE