Provider Demographics
NPI:1528001526
Name:ISIDRO G DELEON DO PA
Entity Type:Organization
Organization Name:ISIDRO G DELEON DO PA
Other - Org Name:SEALY FAMILY PRACTICE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ISIDRO
Authorized Official - Middle Name:G
Authorized Official - Last Name:DE LEON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:979-627-0795
Mailing Address - Street 1:826 S MEYER ST
Mailing Address - Street 2:
Mailing Address - City:SEALY
Mailing Address - State:TX
Mailing Address - Zip Code:77474-3433
Mailing Address - Country:US
Mailing Address - Phone:979-627-0795
Mailing Address - Fax:979-627-0799
Practice Address - Street 1:826 S MEYER ST
Practice Address - Street 2:
Practice Address - City:SEALY
Practice Address - State:TX
Practice Address - Zip Code:77474-3433
Practice Address - Country:US
Practice Address - Phone:979-627-0795
Practice Address - Fax:979-627-0799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7714207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX144735101Medicaid
TX00515ROtherBCBS
TX5658340001OtherMEDICARE NSC
TX00515ROtherMEDICARE
TXCH7975OtherRAILROAD MEDICARE