Provider Demographics
NPI:1598795858
Name:DELEON, JORY SHANE (CP,LP)
Entity Type:Individual
Prefix:
First Name:JORY
Middle Name:SHANE
Last Name:DELEON
Suffix:
Gender:M
Credentials:CP,LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 WESTMEADOW DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033-4024
Mailing Address - Country:US
Mailing Address - Phone:817-556-3699
Mailing Address - Fax:817-556-3877
Practice Address - Street 1:105 WESTMEADOW DR
Practice Address - Street 2:SUITE C
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-4024
Practice Address - Country:US
Practice Address - Phone:817-556-3699
Practice Address - Fax:817-556-3877
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5791744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5656850001Medicare ID - Type UnspecifiedPALMETTO/MEDICARE