Provider Demographics
NPI:1902861099
Name:LEECH, RICHARD COLLIER (D O)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:COLLIER
Last Name:LEECH
Suffix:
Gender:M
Credentials:D O
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9105 INDIAN KNOLL TRL
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76180-1245
Mailing Address - Country:US
Mailing Address - Phone:817-498-5343
Mailing Address - Fax:
Practice Address - Street 1:729 W BEDFORD EULESS RD
Practice Address - Street 2:SUITE 100
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76053-3939
Practice Address - Country:US
Practice Address - Phone:817-282-6905
Practice Address - Fax:817-282-0939
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXC9302207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXA67326Medicare UPIN