Provider Demographics
NPI:1790083111
Name:LEON R. BRILL, D.P.M., F.A.C.F.A.S., P.A.
Entity Type:Organization
Organization Name:LEON R. BRILL, D.P.M., F.A.C.F.A.S., P.A.
Other - Org Name:NORTH TEXAS PODIATRIC MEDICINE AND SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LEON
Authorized Official - Middle Name:R
Authorized Official - Last Name:BRILL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:214-369-7400
Mailing Address - Street 1:5481 BLAIR RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4101
Mailing Address - Country:US
Mailing Address - Phone:214-369-7400
Mailing Address - Fax:
Practice Address - Street 1:5481 BLAIR RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4101
Practice Address - Country:US
Practice Address - Phone:214-369-7400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-09
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0628213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX092803802Medicaid
TX092803802Medicaid