Provider Demographics
NPI:1407957202
Name:DELEON, MARIA L (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:L
Last Name:DELEON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1023 N MOUND ST
Mailing Address - Street 2:SUITE I
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75961
Mailing Address - Country:US
Mailing Address - Phone:936-552-7400
Mailing Address - Fax:936-552-7406
Practice Address - Street 1:1023 N MOUND ST
Practice Address - Street 2:SUITE I
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75961
Practice Address - Country:US
Practice Address - Phone:936-552-7400
Practice Address - Fax:936-552-7406
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK04522084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX030183001Medicaid
TX0052GKOtherBLUE CROSS/BLUE SHIELD
TX130023588OtherRAILROAD MEDICARE
TX030183001Medicaid
TX130023588OtherRAILROAD MEDICARE