Provider Demographics
NPI:1770759078
Name:LEEDY, WILLIAM HOWE JR (CRNA)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:HOWE
Last Name:LEEDY
Suffix:JR
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 WOODBERRY DR
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-5324
Mailing Address - Country:US
Mailing Address - Phone:936-671-3974
Mailing Address - Fax:
Practice Address - Street 1:1200 ENCLAVE PKWY STE 200
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-1733
Practice Address - Country:US
Practice Address - Phone:800-444-5628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX572589367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered