Provider Demographics
NPI:1275516700
Name:DELEON, JOHN J JR (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:DELEON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1303 MCCULLOUGH AVE
Mailing Address - Street 2:SUITE 166
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-5609
Mailing Address - Country:US
Mailing Address - Phone:210-225-4444
Mailing Address - Fax:210-223-5575
Practice Address - Street 1:1303 MCCULLOUGH AVE
Practice Address - Street 2:SUITE 166
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-5609
Practice Address - Country:US
Practice Address - Phone:210-225-4444
Practice Address - Fax:210-223-5575
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-29
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXF6565208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC15171Medicare UPIN
TX00PB04Medicare ID - Type Unspecified