Provider Demographics
NPI:1164439352
Name:DINGLER, LEONARD THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:LEONARD
Middle Name:THOMAS
Last Name:DINGLER
Suffix:
Gender:M
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:P.O. BOX 30
Mailing Address - Street 2:
Mailing Address - City:NOCONA
Mailing Address - State:TX
Mailing Address - Zip Code:76255
Mailing Address - Country:US
Mailing Address - Phone:940-825-3333
Mailing Address - Fax:940-825-3052
Practice Address - Street 1:90 PARK RD.
Practice Address - Street 2:
Practice Address - City:NOCONA
Practice Address - State:TX
Practice Address - Zip Code:76255
Practice Address - Country:US
Practice Address - Phone:940-825-3333
Practice Address - Fax:940-825-3052
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH3873207Q00000X
OK21823207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX453876OtherMEDICARE PART A RHC
OK100167950BOtherOKLAHOMA MEDICAID
TX139967705Medicaid
TX00D971OtherMEDICARE PART B GROUP
TX80F834OtherBC/BS
TX00D971OtherMEDICARE PART B GROUP
TX80F834Medicare PIN
TX453876OtherMEDICARE PART A RHC