Provider Demographics
NPI:1588660047
Name:MABRY, LEAH RAYE (MD)
Entity Type:Individual
Prefix:DR
First Name:LEAH RAYE
Middle Name:
Last Name:MABRY
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 1:333 N. SANTA ROSA
Mailing Address - Street 2:CENTER FOR CHILDREN & FAMILIES, SUITE 4703
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78207
Mailing Address - Country:US
Mailing Address - Phone:210-704-2535
Mailing Address - Fax:210-704-2545
Practice Address - Street 1:333 N. SANTA ROSA
Practice Address - Street 2:CENTER FOR CHILDREN & FAMILIES, 4TH FLOOR
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207
Practice Address - Country:US
Practice Address - Phone:210-704-4140
Practice Address - Fax:210-704-4136
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3574207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5986554OtherAETNA
TX2224540OtherBLUELINK ACCESS
TX130776107OtherCIDC
TX436404OtherPRIVATE HEALTHCARE SYST
TX773119OtherFIRST HEALTH
TX85747FOtherBCBS OF TEXAS
TX742806531EOtherHUMANA
TX130776102Medicaid
TX7677915002OtherCIGNA
TX130776107OtherCIDC
TXB24540Medicare UPIN