Provider Demographics
NPI:1417213455
Name:MCLEOD, CRYSTAL (DO)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:MCLEOD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 S BUCKNER BLVD
Mailing Address - Street 2:SUITE 139
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75217-1704
Mailing Address - Country:US
Mailing Address - Phone:469-488-4400
Mailing Address - Fax:469-488-4401
Practice Address - Street 1:306 N LOOP 288 STE 200
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76209-4958
Practice Address - Country:US
Practice Address - Phone:940-381-1501
Practice Address - Fax:940-591-7830
Is Sole Proprietor?:No
Enumeration Date:2012-04-04
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXP7310208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program