Provider Demographics
NPI:1033201488
Name:ALTENBERG, LEO LAWRENCE (MD)
Entity Type:Individual
Prefix:DR
First Name:LEO
Middle Name:LAWRENCE
Last Name:ALTENBERG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:154 N FESTIVAL DR
Mailing Address - Street 2:STE A
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-6265
Mailing Address - Country:US
Mailing Address - Phone:915-271-8400
Mailing Address - Fax:915-300-0115
Practice Address - Street 1:154 N FESTIVAL DR
Practice Address - Street 2:STE A
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-6265
Practice Address - Country:US
Practice Address - Phone:806-647-2194
Practice Address - Fax:806-647-3769
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2022-03-03
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Provider Licenses
StateLicense IDTaxonomies
TXG7975207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX611668Medicare ID - Type Unspecified