Provider Demographics
NPI:1871738286
Name:FALCON, LEIGH ANN (MD)
Entity type:Individual
Prefix:
First Name:LEIGH
Middle Name:ANN
Last Name:FALCON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LEIGH
Other - Middle Name:ANN
Other - Last Name:JEDLICKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1200 N VIRGINIA ST
Mailing Address - Street 2:
Mailing Address - City:PORT LAVACA
Mailing Address - State:TX
Mailing Address - Zip Code:77979-2507
Mailing Address - Country:US
Mailing Address - Phone:361-552-6721
Mailing Address - Fax:361-552-7463
Practice Address - Street 1:1200 N VIRGINIA ST
Practice Address - Street 2:
Practice Address - City:PORT LAVACA
Practice Address - State:TX
Practice Address - Zip Code:77979-2507
Practice Address - Country:US
Practice Address - Phone:361-552-6721
Practice Address - Fax:361-552-7463
Is Sole Proprietor?:No
Enumeration Date:2008-12-14
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN1629207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine