Individual
DR. JANE H LEIDLEIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
117 CIRCLE WAY ST, LAKE JACKSON, TX 77566-5233
(979) 297-4042
Mailing address
117 CIRCLE WAY ST, LAKE JACKSON, TX 77566-5233
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
J4298
TX
207WX0107X
Retina Specialist (Ophthalmology) Physician
J4298
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
096931301
—
TX
05
—
096931303
—
TX
01
—
10017638
AMERIGROUP
TX
01
—
180036211
RAILROAD MEDICARE
TX
01
—
8S4250
BCBS
TX
Enumeration date
11/10/2005
Last updated
06/02/2022
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