Provider Demographics
NPI:1669680823
Name:LEONG, DOROTHY ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:DOROTHY
Middle Name:ANN
Last Name:LEONG
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:PO BOX 262569
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75026-2569
Mailing Address - Country:US
Mailing Address - Phone:972-321-1415
Mailing Address - Fax:
Practice Address - Street 1:12870 HILLCREST RD STE 201
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-6550
Practice Address - Country:US
Practice Address - Phone:972-321-1415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH3214208100000X
AZ19247208100000X
CAA47720208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX88W811Medicare ID - Type Unspecified
TXC18335Medicare UPIN