Provider Demographics
NPI:1891886545
Name:LEAHEY, THOMAS B (DO)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:B
Last Name:LEAHEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 6036
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73403-1036
Mailing Address - Country:US
Mailing Address - Phone:580-226-2202
Mailing Address - Fax:580-226-3354
Practice Address - Street 1:2015 W BROADWAY ST STE 2A
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-2560
Practice Address - Country:US
Practice Address - Phone:580-226-2202
Practice Address - Fax:580-307-6790
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2708207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK73149603000OtherHEALTHCHOICE
OK110179812OtherRAILROAD MEDICARE
OK731496030002OtherBCBS OF OK PROVIDER #
OK110179812OtherPREFERRED COMMUNITY CHOIC
OK731496030OtherCHAMPUS/TRICARE
OK73149603000OtherHEALTHCHOICE