Provider Demographics
NPI:1255330940
Name:LEEAH, BENJAMIN J (MD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:J
Last Name:LEEAH
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 1:9601 SPUR 591
Mailing Address - Street 2:WILLIAM P. CLEMENTS, JR. UNIT
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79107-9606
Mailing Address - Country:US
Mailing Address - Phone:806-381-7080
Mailing Address - Fax:806-381-0417
Practice Address - Street 1:9601 SPUR 591
Practice Address - Street 2:WILLIAM P. CLEMENTS, JR. UNIT
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79107-9606
Practice Address - Country:US
Practice Address - Phone:806-381-7080
Practice Address - Fax:806-381-0417
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5020207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0016KHOtherBCBS
TXL5020OtherSTATE MEDICAL LICENSE
TX680574937OtherTAX ID
TX159401201Medicaid
TX007614479OtherAETNA
TX007614479OtherAETNA
TXH89233Medicare UPIN
TXL5020OtherSTATE MEDICAL LICENSE