Provider Demographics
NPI:1568617355
Name:ARENIVAR, LEROY (MD)
Entity Type:Individual
Prefix:
First Name:LEROY
Middle Name:
Last Name:ARENIVAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 E UNIVERSITY AVE
Mailing Address - Street 2:200
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-6814
Mailing Address - Country:US
Mailing Address - Phone:877-500-5722
Mailing Address - Fax:
Practice Address - Street 1:11111 RESEARCH BLVD STE 310
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-5792
Practice Address - Country:US
Practice Address - Phone:877-500-5722
Practice Address - Fax:512-605-6400
Is Sole Proprietor?:No
Enumeration Date:2008-11-20
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP63272084P0800X
TXBP100287382084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3236424-01Medicaid
TX299508YMP3OtherMEDICARE