Provider Demographics
NPI:1073746160
Name:CONDRY, LEESA BLAKE (MD)
Entity Type:Individual
Prefix:DR
First Name:LEESA
Middle Name:BLAKE
Last Name:CONDRY
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 1:3605 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75205-3916
Mailing Address - Country:US
Mailing Address - Phone:214-526-7995
Mailing Address - Fax:214-522-1460
Practice Address - Street 1:3605 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75205-3916
Practice Address - Country:US
Practice Address - Phone:214-526-7995
Practice Address - Fax:214-522-1460
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-24
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE9043207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology