Provider Demographics
NPI:1760482319
Name:LEATH, BROOKE GURKIN (MD)
Entity Type:Individual
Prefix:DR
First Name:BROOKE
Middle Name:GURKIN
Last Name:LEATH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:BROOKE
Other - Middle Name:GURKIN
Other - Last Name:LEATH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4658
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:302 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-1032
Practice Address - Country:US
Practice Address - Phone:512-509-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200200248207V00000X
TXM4272207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891370GMedicaid
NC2032067Medicare ID - Type UnspecifiedMEDICARE
NC891370GMedicaid