Basic Information
| Provider Information | |||||||||
| NPI: | 1114910411 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEACH | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | JAMES | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5002 COWHORN CREEK RD | ||||||||
| Address2: | |||||||||
| City: | TEXARKANA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 755039766 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9036143000 | ||||||||
| FaxNumber: | 9036143525 | ||||||||
| Practice Location | |||||||||
| Address1: | 5002 COWHORN CREEK RD | ||||||||
| Address2: | |||||||||
| City: | TEXARKANA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 755039766 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9036143000 | ||||||||
| FaxNumber: | 9036143525 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2005 | ||||||||
| LastUpdateDate: | 10/24/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | 42232 | CO | N | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 207RN0300X | 6419970-1205 | UT | N | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 207RN0300X | M9032 | ID | N | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 207RN0300X | E11089 | AR | N | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 207RN0300X | 3520 | OK | N | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 208M00000X | 6419970-1205 | UT | N | Allopathic & Osteopathic Physicians | Hospitalist | 207RN0300X | R1810 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
No ID Information.