Provider Demographics
NPI:1467689604
Name:LEEDS, STEVEN GARY (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:GARY
Last Name:LEEDS
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 1:3410 WORTH ST. SUITE 235
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246
Mailing Address - Country:US
Mailing Address - Phone:214-820-0434
Mailing Address - Fax:214-820-0435
Practice Address - Street 1:3410 WORTH ST. SUITE 235
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246
Practice Address - Country:US
Practice Address - Phone:214-820-0434
Practice Address - Fax:201-482-0043
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-15
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP7942208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3305542-01Medicaid