Individual
COLLIN LEACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2801 FRANCISCAN DR, BRYAN, TX 77802-2544
(979) 776-2537
(979) 776-2526
Mailing address
2801 FRANCISCAN DR, BRYAN, TX 77802-2544
(979) 776-2537
(979) 776-2526
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
T3322
TX
208M00000X
Hospitalist Physician
T3322
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
429296301
—
TX
01
—
Q00258489
RR MEDICARE
TX
01
—
T3322
TX STATE LICENSE
TX
Enumeration date
04/05/2018
Last updated
08/30/2022
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