Individual
JEFFREY K LEITKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1845 PRECINCT LINE RD STE 209, SECOND FLOOR, HURST, TX 76054-3109
(817) 336-4638
(817) 336-7637
Mailing address
1845 PRECINCT LINE RD STE 209, SECOND FLOOR, HURST, TX 76054-3109
(817) 336-4638
(817) 336-7637
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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