Basic Information
| Provider Information | |||||||||
| NPI: | 1508849696 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEEMAN | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | JAMES | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3607 MANOR RD STE 101 | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787235818 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124782273 | ||||||||
| FaxNumber: | 5124720921 | ||||||||
| Practice Location | |||||||||
| Address1: | 3607 MANOR RD STE 101 | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124782273 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/22/2005 | ||||||||
| LastUpdateDate: | 01/17/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207YX0905X | L0373 | TX | Y | Allopathic & Osteopathic Physicians | Otolaryngology | Otolaryngology/Facial Plastic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 038350701 | 05 | TX | MEDICAID | 8A3850 | 01 | TX | BCBS PROVIDER # | OTHER |