Provider Demographics
NPI:1598965907
Name:DE LEON, DEXTER G (MD)
Entity Type:Individual
Prefix:DR
First Name:DEXTER
Middle Name:G
Last Name:DE LEON
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 1:6320 N LA CHOLLA BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-3552
Mailing Address - Country:US
Mailing Address - Phone:520-545-0953
Mailing Address - Fax:
Practice Address - Street 1:6320 N LA CHOLLA BLVD STE 300
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-3552
Practice Address - Country:US
Practice Address - Phone:520-545-0953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0116018141207R00000X
AZ52334207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine