Provider Demographics
NPI:1447210729
Name:LEONARD, TERRY A (PA-C)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:A
Last Name:LEONARD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:527 N LEONA ST
Mailing Address - Street 2:MS 49-2
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78207-3110
Mailing Address - Country:US
Mailing Address - Phone:210-358-3401
Mailing Address - Fax:210-358-3664
Practice Address - Street 1:527 N LEONA ST
Practice Address - Street 2:MS 49-2
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-3110
Practice Address - Country:US
Practice Address - Phone:210-358-3401
Practice Address - Fax:210-358-3664
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA01905363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP01818Medicare UPIN
TX86N632Medicare ID - Type Unspecified