Doctor Name: | DR. JEREMY D LELAND |
NPI Number: | 1629251624 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | DDS MD |
License Number: | |
Business Practice Address: | 3622 Williams Dr Bldg 1 Georgetown, TX - 786282415 |
Business Phone Number: | 5128690529 |
Business Fax Number: | 5124980154 |
Mailing Address: | Po Box 49500, AUSTIN |
State: | TX |
Postal Code: | 787659500 |
Phone Number: | 5124541220 |
Fax Number: | 5124670363 |
NPI Enumeration Date: | 12/12/2007 |
NPI Last Update Date: | 09/19/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |