Provider Demographics
NPI:1932156213
Name:LEONARD, BRADLEY M (MD)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:M
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 1:5450 CLEARFORK MAIN ST STE 230
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-3562
Mailing Address - Country:US
Mailing Address - Phone:817-641-6000
Mailing Address - Fax:817-419-4501
Practice Address - Street 1:5450 CLEARFORK MAIN ST STE 230
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-3562
Practice Address - Country:US
Practice Address - Phone:817-641-6000
Practice Address - Fax:817-419-4501
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3554207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3205112OtherBLUELINK
TXP00216787OtherRR MCARE
TX125536606Medicaid
TX3205112OtherBLUELINK