Provider Demographics
NPI:1497962344
Name:GEORGE W DELEON MD PA
Entity Type:Organization
Organization Name:GEORGE W DELEON MD PA
Other - Org Name:GEORGE W. DELEON MD PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:DELEON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:979-205-9028
Mailing Address - Street 1:303 N. MCKINNEY STREET
Mailing Address - Street 2:SUITE C
Mailing Address - City:SWEENY
Mailing Address - State:TX
Mailing Address - Zip Code:77480
Mailing Address - Country:US
Mailing Address - Phone:979-205-9028
Mailing Address - Fax:979-548-2508
Practice Address - Street 1:303 N. MCKINNEY STREET
Practice Address - Street 2:SUITE C
Practice Address - City:SWEENY
Practice Address - State:TX
Practice Address - Zip Code:77480
Practice Address - Country:US
Practice Address - Phone:979-205-9028
Practice Address - Fax:979-548-2508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG1370261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX110420002Medicaid
TX00QA32Medicare ID - Type Unspecified
TXC15170Medicare UPIN