Provider Demographics
NPI:1528002250
Name:LEO A. CONGER JR., M.D. PA
Entity Type:Organization
Organization Name:LEO A. CONGER JR., M.D. PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEO
Authorized Official - Middle Name:ARNOLD
Authorized Official - Last Name:CONGER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:254-778-5400
Mailing Address - Street 1:1300 E 6TH AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BELTON
Mailing Address - State:TX
Mailing Address - Zip Code:76513-2810
Mailing Address - Country:US
Mailing Address - Phone:254-778-5400
Mailing Address - Fax:254-778-5444
Practice Address - Street 1:1300 E 6TH AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:BELTON
Practice Address - State:TX
Practice Address - Zip Code:76513-2810
Practice Address - Country:US
Practice Address - Phone:254-778-5400
Practice Address - Fax:254-778-5444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8813174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherTAX ID
TX=========OtherTAX ID