Provider Demographics
NPI:1275629586
Name:LUIS LEYTON MD PA
Entity Type:Organization
Organization Name:LUIS LEYTON MD PA
Other - Org Name:CORPUS CHRISTI DIAGNOSTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:E
Authorized Official - Last Name:LEYTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-785-8282
Mailing Address - Street 1:PO BOX 61210
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78466-1210
Mailing Address - Country:US
Mailing Address - Phone:210-785-8282
Mailing Address - Fax:210-785-8288
Practice Address - Street 1:5920 SARATOGA BLVD
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-4103
Practice Address - Country:US
Practice Address - Phone:210-785-8282
Practice Address - Fax:210-785-8288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2416207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX175429301Medicaid
TXH33650Medicare UPIN
TX175429301Medicaid