Provider Demographics
NPI:1548539687
Name:LEAH EBERLEY MD PLLC
Entity type:Organization
Organization Name:LEAH EBERLEY MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:TREHARNE-ESPARZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-532-6069
Mailing Address - Street 1:1201 E SCHUSTER AVE STE 4A
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-4646
Mailing Address - Country:US
Mailing Address - Phone:915-532-6069
Mailing Address - Fax:915-532-1335
Practice Address - Street 1:1201 E SCHUSTER AVE STE 4A
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-4646
Practice Address - Country:US
Practice Address - Phone:915-532-6069
Practice Address - Fax:915-532-1335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-19
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2059207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00K43NMedicare UPIN