1609049436 NPI number — TEMEKKA VE'SHAWN LEDAY M.D., PH.D.

Table of content: TEMEKKA VE'SHAWN LEDAY M.D., PH.D. (NPI 1609049436)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609049436 NPI number — TEMEKKA VE'SHAWN LEDAY M.D., PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEDAY
Provider First Name:
TEMEKKA
Provider Middle Name:
VE'SHAWN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D., PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609049436
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/01/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2501 SOUTH STATE HWY 121 BUSINESS
Provider Second Line Business Mailing Address:
SUITE 1210
Provider Business Mailing Address City Name:
LEWISVILLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75067-8188
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-966-7828
Provider Business Mailing Address Fax Number:
972-966-7899

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2501 SOUTH STATE HWY 121 BUSINESS
Provider Second Line Business Practice Location Address:
SUITE 1210
Provider Business Practice Location Address City Name:
LEWISVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75067-8188
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-966-7828
Provider Business Practice Location Address Fax Number:
972-966-7899
Provider Enumeration Date:
04/13/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207ZH0000X , with the licence number:  P2285 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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