Provider Demographics
NPI:1720182223
Name:MCLEOD, ALONZO LUCIEN (DO)
Entity Type:Individual
Prefix:
First Name:ALONZO
Middle Name:LUCIEN
Last Name:MCLEOD
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 1:5959 WEST LOOP SOUTH
Mailing Address - Street 2:#445
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401
Mailing Address - Country:US
Mailing Address - Phone:713-838-0892
Mailing Address - Fax:713-838-8529
Practice Address - Street 1:5959 WEST LOOP SOUTH
Practice Address - Street 2:#445
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401
Practice Address - Country:US
Practice Address - Phone:713-838-0892
Practice Address - Fax:713-838-8529
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD8573207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C19196Medicare UPIN
R768Medicare ID - Type Unspecified