Provider Demographics
NPI:1013161652
Name:PLATO, LEAH L (PA)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:L
Last Name:PLATO
Suffix:
Gender:F
Credentials:PA
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 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-234-2987
Practice Address - Street 1:7777 FOREST LN STE C707
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-6861
Practice Address - Country:US
Practice Address - Phone:972-566-3000
Practice Address - Fax:972-566-3099
Is Sole Proprietor?:No
Enumeration Date:2008-11-10
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05945363AM0700X
MI5601005667363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX342754401Medicaid
TX342754401Medicaid
MI0M08620036Medicare PIN
TX387940YM09Medicare PIN