Individual
DR. THOMAS A. LEAVENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1307 8TH AVE, #408, FORT WORTH, TX 76104-4137
(817) 921-4191
(817) 924-3096
Mailing address
221 W. COLORADO BLVD. PAVILLION 2, SUITE 537, DALLAS, TX 75208
(214) 943-4599
(214) 942-3549
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
J3335
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PO84930F9
—
TX
Enumeration date
08/23/2005
Last updated
05/07/2014
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