Provider Demographics
NPI:1801908942
Name:LESHNOWER, ALAN C (MD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:C
Last Name:LESHNOWER
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 1:5 SANTA FE PL
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79765-8520
Mailing Address - Country:US
Mailing Address - Phone:432-563-5373
Mailing Address - Fax:866-730-6998
Practice Address - Street 1:1220 W UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79764-7118
Practice Address - Country:US
Practice Address - Phone:432-332-6600
Practice Address - Fax:866-730-6998
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG0756208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG0756OtherMEDICAL LICENSE
TX131224108Medicaid
TX8A8865Medicare PIN
TXG0756OtherMEDICAL LICENSE