Individual
CHARLES RAYMOND LEACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4440 E HIGHWAY 287, MIDLOTHIAN, TX 76065-5576
(972) 723-5590
(972) 723-5592
Mailing address
4440 E HIGHWAY 287, MIDLOTHIAN, TX 76065-5576
(972) 723-5590
(972) 723-5592
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
F4922
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110094182
RAILROAD MEDICARE
TX
05
—
131879204
—
TX
05
—
131879208
—
TX
05
—
131879218
—
TX
01
—
131879221
MEDICAID OTHER
TX
01
—
283520YL7A
MEDICARE - OTHER COUNTY
TX
Enumeration date
06/13/2006
Last updated
09/05/2014
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