Provider Demographics
NPI:1720002793
Name:DELEON, JEAN MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:MARIE
Last Name:DELEON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3504 SWISS AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-6224
Mailing Address - Country:US
Mailing Address - Phone:214-820-9895
Mailing Address - Fax:214-820-9689
Practice Address - Street 1:3504 SWISS AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-6224
Practice Address - Country:US
Practice Address - Phone:214-820-9895
Practice Address - Fax:214-820-9689
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4074208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F8835OtherBCBS
TX119336904Medicaid
TX119336905Medicaid
TX8J3885Medicare PIN
TX119336905Medicaid
TX8F8835OtherBCBS
TX119336904Medicaid
TXTXB121393Medicare PIN