Provider Demographics
NPI:1215040183
Name:TINDALL, LEAH BAXTER (MD)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:BAXTER
Last Name:TINDALL
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 1:1003 HEMINGWAY DR
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-5687
Mailing Address - Country:US
Mailing Address - Phone:979-694-9954
Mailing Address - Fax:
Practice Address - Street 1:1605 ROCK PRAIRIE RD
Practice Address - Street 2:STE 212
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-8358
Practice Address - Country:US
Practice Address - Phone:979-680-0361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3025207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine