Basic Information
| Provider Information | |||||||||
| NPI: | 1780709675 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMPREHENSIVE ENT CENTER OF TEXAS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3607 MANOR RD | ||||||||
| Address2: | #101 | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124782273 | ||||||||
| FaxNumber: | 5124720921 | ||||||||
| Practice Location | |||||||||
| Address1: | 3607 MANOR RD STE 101 | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787235818 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124782273 | ||||||||
| FaxNumber: | 5124720921 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2007 | ||||||||
| LastUpdateDate: | 05/24/2022 | ||||||||
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| AuthorizedOfficialLastName: | LEEMAN | ||||||||
| AuthorizedOfficialFirstName: | DANIEL | ||||||||
| AuthorizedOfficialMiddleName: | JAMES | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5124782273 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 05/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 0022EV | 01 | TX | BCBS GROUP # | OTHER | 081445101 | 05 | TX | MEDICAID |