Individual
JEFFREY K LEITKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
052198
GA
2085R0202X
Diagnostic Radiology Physician
M5813
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
052198
STATE MEDICAL LICENSE
GA
05
—
188618601
—
TX
01
—
26572
STATE MEDICAL LICENSE
OK
01
—
M5813
STATE MEDICAL LICENSE
TX
01
—
P00463013
RR MEDICARE
TX
Enumeration date
02/19/2007
Last updated
08/18/2016
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