Provider Demographics
NPI:1083814057
Name:LEON, SERGIO A (MD)
Entity Type:Individual
Prefix:DR
First Name:SERGIO
Middle Name:A
Last Name:LEON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 SAINT MICHAEL DR STE 401
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-5211
Mailing Address - Country:US
Mailing Address - Phone:903-614-5367
Mailing Address - Fax:903-614-5343
Practice Address - Street 1:3030 NORTH ST STE 450
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1434
Practice Address - Country:US
Practice Address - Phone:409-832-9600
Practice Address - Fax:409-832-9310
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 104595207RR0500X
MDD0071211207RR0500X
VA0101249525207RR0500X
TXS4806207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX939915OtherMEDICARE
FLP00815670OtherRAILROAD MEDICARE
TX1K1864OtherMEDICARE
TXP02601534OtherMCRR