Provider Demographics
NPI:1700988714
Name:LEIFESTE, ALAN E II (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:E
Last Name:LEIFESTE
Suffix:II
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 1219
Mailing Address - Street 2:
Mailing Address - City:BURNET
Mailing Address - State:TX
Mailing Address - Zip Code:78611-7219
Mailing Address - Country:US
Mailing Address - Phone:512-715-3106
Mailing Address - Fax:325-388-6935
Practice Address - Street 1:525 RR 2900
Practice Address - Street 2:
Practice Address - City:KINGSLAND
Practice Address - State:TX
Practice Address - Zip Code:78639-6000
Practice Address - Country:US
Practice Address - Phone:512-715-3106
Practice Address - Fax:325-388-6935
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM7091207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXI36989Medicare UPIN
TXP00400251Medicare PIN
TXI36989Medicare UPIN
TX178269002Medicaid