Provider Demographics
NPI:1437388907
Name:LEON, JOSE AGUSTIN (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:AGUSTIN
Last Name:LEON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JOSE
Other - Middle Name:AGUSTIN
Other - Last Name:LEON DE LA ROCHA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1907 S COLLEGE ST STE 201
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36832-5906
Mailing Address - Country:US
Mailing Address - Phone:334-203-6196
Mailing Address - Fax:334-231-5093
Practice Address - Street 1:1907 S COLLEGE ST STE 201
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36832-5906
Practice Address - Country:US
Practice Address - Phone:334-203-6196
Practice Address - Fax:334-231-5093
Is Sole Proprietor?:No
Enumeration Date:2009-07-06
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL31742207R00000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL140663Medicaid