Provider Demographics
NPI:1245255009
Name:BRUCE LEIPZIG, M.D, PA
Entity type:Organization
Organization Name:BRUCE LEIPZIG, M.D, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEIPZIG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:325-643-5695
Mailing Address - Street 1:2410 CROCKETT DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:BROWNWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76801-5906
Mailing Address - Country:US
Mailing Address - Phone:325-643-5695
Mailing Address - Fax:325-643-1193
Practice Address - Street 1:2410 CROCKETT DR
Practice Address - Street 2:SUITE B
Practice Address - City:BROWNWOOD
Practice Address - State:TX
Practice Address - Zip Code:76801-5906
Practice Address - Country:US
Practice Address - Phone:325-643-5695
Practice Address - Fax:325-643-1193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF1114207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1657590201Medicaid
TX00967VMedicare ID - Type Unspecified
TX1657590201Medicaid