Individual
DR. JO A LEUCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1301 PENNSYLVANIA AVE, FORT WORTH, TX 76104-2122
(817) 451-4208
Mailing address
PO BOX 650823, DEPT 41534, DALLAS, TX 75265-0823
(817) 702-3431
(405) 341-9217
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
127719
NC
207P00000X
Emergency Medicine Physician
2008-00764
NC
207P00000X
Emergency Medicine Physician
Primary
P8798
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2008-00764
STATE LICENSE
NC
05
—
5909993
—
NC
05
—
N0076J
—
SC
Enumeration date
03/06/2007
Last updated
04/03/2018
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