Provider Demographics
NPI:1609842442
Name:LEISTEN, ROBERT D (DPM)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:D
Last Name:LEISTEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1740 W 27TH ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-1440
Mailing Address - Country:US
Mailing Address - Phone:713-862-3357
Mailing Address - Fax:713-862-8328
Practice Address - Street 1:1740 W 27TH ST
Practice Address - Street 2:SUITE 110
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-1440
Practice Address - Country:US
Practice Address - Phone:713-862-3357
Practice Address - Fax:713-862-8328
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0786213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX085279001Medicaid
TX82Y990OtherBCBS
TX092839201Medicaid
TX092839201Medicaid
TX480001431Medicare PIN
TX085279001Medicaid
TX82Y990OtherBCBS
TX00T49RMedicare PIN