Provider Demographics
NPI:1285679779
Name:ROYSTON, LEON DENSON JR (PA)
Entity Type:Individual
Prefix:
First Name:LEON
Middle Name:DENSON
Last Name:ROYSTON
Suffix:JR
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2012 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-6727
Mailing Address - Country:US
Mailing Address - Phone:530-899-4791
Mailing Address - Fax:530-893-6184
Practice Address - Street 1:2012 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-6727
Practice Address - Country:US
Practice Address - Phone:530-899-4791
Practice Address - Fax:530-893-6184
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA12790363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA12790OtherLICENSE
CAPA12790OtherLICENSE
CAPA12790OtherLICENSE