Provider Demographics
NPI:1518156736
Name:ENRIQUE A LEAL MD
Entity Type:Organization
Organization Name:ENRIQUE A LEAL MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ENRIQUE
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:936-288-3722
Mailing Address - Street 1:318 W COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:SAN AUGUSTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75972-1820
Mailing Address - Country:US
Mailing Address - Phone:936-288-3722
Mailing Address - Fax:
Practice Address - Street 1:318 W COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:SAN AUGUSTINE
Practice Address - State:TX
Practice Address - Zip Code:75972-1820
Practice Address - Country:US
Practice Address - Phone:936-288-3722
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8896207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG8896OtherLICENSE
TX00455HMedicare PIN
TXF91498Medicare UPIN