Individual
THOMAS MICHAEL LEATH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M. D.
Contact information
Practice address
3410 FAR WEST BLVD, SUITE 146, AUSTIN, TX 78731-3194
(512) 349-0777
(512) 349-9111
Mailing address
PO BOX 603725, CHARLOTTE, NC 28260-3725
(828) 575-2625
(828) 350-2174
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
M4273
TX
207KA0200X
Allergy Physician
M4273
TX
2080P0201X
Pediatric Allergy/Immunology Physician
M4273
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
752741
MEDICARE PTAN
TX
Enumeration date
08/11/2006
Last updated
10/31/2023
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