Provider Demographics
NPI:1811057359
Name:HADDOCK, LEANN E (MD)
Entity type:Individual
Prefix:DR
First Name:LEANN
Middle Name:E
Last Name:HADDOCK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 GASTON AVENUE
Mailing Address - Street 2:BARNETT #601
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246
Mailing Address - Country:US
Mailing Address - Phone:214-824-2547
Mailing Address - Fax:214-824-8365
Practice Address - Street 1:3600 GASTON AVENUE
Practice Address - Street 2:BARNETT #601
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246
Practice Address - Country:US
Practice Address - Phone:214-824-2547
Practice Address - Fax:214-824-8365
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6413207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H90874Medicare UPIN
8A9259Medicare ID - Type Unspecified