Individual
LERIS IDEHEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4302 CAT TAIL WAY, FORNEY, TX 75126-2559
(214) 283-6759
Mailing address
4302 CAT TAIL WAY, FORNEY, TX 75126-2559
Taxonomy
Speciality
Code
Description
License number
State
261QX0100X
Occupational Medicine Clinic/Center
Primary
—
—
Other
Enumeration date
10/21/2022
Last updated
10/21/2022
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