Provider Demographics
NPI:1073505046
Name:LEON, FELIX IVAN (MD)
Entity Type:Individual
Prefix:MR
First Name:FELIX
Middle Name:IVAN
Last Name:LEON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 192054
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-2054
Mailing Address - Country:US
Mailing Address - Phone:787-754-8489
Mailing Address - Fax:787-751-0861
Practice Address - Street 1:1724 CALLE YANGTZE
Practice Address - Street 2:RIO PIEDRAS HEIGHTS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-3104
Practice Address - Country:US
Practice Address - Phone:787-754-8489
Practice Address - Fax:787-751-0861
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4209207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR25184Medicare ID - Type Unspecified
D48281Medicare UPIN