Provider Demographics
NPI:1295730554
Name:MCCARTER, LEO DEWITT (MD)
Entity type:Individual
Prefix:
First Name:LEO
Middle Name:DEWITT
Last Name:MCCARTER
Suffix:
Gender:M
Credentials:MD
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 840853
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-0853
Mailing Address - Country:US
Mailing Address - Phone:972-715-5000
Mailing Address - Fax:
Practice Address - Street 1:6606 LBJ FWY STE 200
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-6524
Practice Address - Country:US
Practice Address - Phone:972-715-5000
Practice Address - Fax:972-715-9976
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2581207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00746630OtherRAILROAD MEDICARE
TX8EH583OtherBCBS TX
TX8BR518OtherBCBS
TX130548409Medicaid
TX130548410Medicaid
TX130548411Medicaid
TX130548412Medicaid
TX8EH583OtherBCBS TX
TX130548410Medicaid
TX8L4438Medicare PIN
TX8L3193Medicare PIN