Provider Demographics
NPI:1558793992
Name:ACEVEDO, LEONARD MATTHEW (PA-C, MPAS)
Entity Type:Individual
Prefix:
First Name:LEONARD
Middle Name:MATTHEW
Last Name:ACEVEDO
Suffix:
Gender:M
Credentials:PA-C, MPAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 NE MALL BLVD
Mailing Address - Street 2:
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76053-4653
Mailing Address - Country:US
Mailing Address - Phone:817-595-4500
Mailing Address - Fax:817-595-4505
Practice Address - Street 1:4724 WELLINGTON ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-4944
Practice Address - Country:US
Practice Address - Phone:903-455-8800
Practice Address - Fax:214-771-3101
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-08
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA08462363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant