Provider Demographics
NPI:1750368957
Name:LEONARD, PETER D (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:D
Last Name:LEONARD
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 1:6957 W PLANO PKWY STE 2400
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-1622
Mailing Address - Country:US
Mailing Address - Phone:214-919-4635
Mailing Address - Fax:214-919-4639
Practice Address - Street 1:6957 W PLANO PKWY STE 2400
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-1622
Practice Address - Country:US
Practice Address - Phone:214-919-4635
Practice Address - Fax:214-919-4639
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF6873207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX128689010Medicaid
TX128689007Medicaid
TX128689009Medicaid
TX128689011Medicaid
TXC18331Medicare UPIN
TX128689007Medicaid
TX128689009Medicaid
8L8262Medicare PIN
TX8D7337Medicare ID - Type Unspecified607K