Provider Demographics
NPI:1760590210
Name:LEON, THEODORE PATRICK (DO)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:PATRICK
Last Name:LEON
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 1:2775 DURNESS CT
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-2228
Mailing Address - Country:US
Mailing Address - Phone:702-456-3825
Mailing Address - Fax:702-456-6795
Practice Address - Street 1:2920 N GREEN VALLEY PKWY
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-0406
Practice Address - Country:US
Practice Address - Phone:702-456-3825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV266207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine