Provider Demographics
NPI:1710017462
Name:DELEON, RICHARD RICK RODRIGO (DO)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:RICK RODRIGO
Last Name:DELEON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 CANYON VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-2029
Mailing Address - Country:US
Mailing Address - Phone:773-789-6757
Mailing Address - Fax:
Practice Address - Street 1:206 CANYON VALLEY DR
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-2029
Practice Address - Country:US
Practice Address - Phone:773-789-6757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ1586207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-115964OtherLICENSE
IN200916530Medicaid
IN140230B4Medicare PIN