Provider Demographics
NPI:1588812283
Name:DIAZ DE LEON, DAVID JR (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:DIAZ DE LEON
Suffix:JR
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 1:19238 STONEHUE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3447
Mailing Address - Country:US
Mailing Address - Phone:210-494-2223
Mailing Address - Fax:210-494-6516
Practice Address - Street 1:2200 ROY RICHARD DR
Practice Address - Street 2:
Practice Address - City:SCHERTZ
Practice Address - State:TX
Practice Address - Zip Code:78154-2723
Practice Address - Country:US
Practice Address - Phone:210-566-4777
Practice Address - Fax:210-566-4779
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN0731208M00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
8BX266OtherBCBS TX
TX197663102Medicaid
TX197663103OtherCSN
TX197663102Medicaid