Provider Demographics
NPI:1164465316
Name:NORDSTROM, LEIGH FURR (MD)
Entity Type:Individual
Prefix:
First Name:LEIGH
Middle Name:FURR
Last Name:NORDSTROM
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 1:1441 S MIDLOTHIAN PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-5591
Mailing Address - Country:US
Mailing Address - Phone:972-723-1474
Mailing Address - Fax:972-723-9423
Practice Address - Street 1:1441 S MIDLOTHIAN PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:MIDLOTHIAN
Practice Address - State:TX
Practice Address - Zip Code:76065-5591
Practice Address - Country:US
Practice Address - Phone:972-723-1474
Practice Address - Fax:972-723-9423
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9400207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8J1474OtherBCBS
TX1670796-02Medicaid
TX8BR060OtherBCBS
TX167079606Medicaid
TX8F9777Medicare PIN
TX8BR060OtherBCBS
TX8J1474OtherBCBS
TX8F3666Medicare PIN
TXP00273550Medicare PIN