Provider Demographics
NPI:1770819880
Name:SCHANEN, LEO JOHN III
Entity Type:Individual
Prefix:MR
First Name:LEO
Middle Name:JOHN
Last Name:SCHANEN
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:643 W LIGUSTRUM BLVD
Mailing Address - Street 2:
Mailing Address - City:ROBSTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78380-2525
Mailing Address - Country:US
Mailing Address - Phone:361-752-0041
Mailing Address - Fax:361-752-0041
Practice Address - Street 1:643 W LIGUSTRUM BLVD
Practice Address - Street 2:
Practice Address - City:ROBSTOWN
Practice Address - State:TX
Practice Address - Zip Code:78380-2525
Practice Address - Country:US
Practice Address - Phone:361-752-0041
Practice Address - Fax:361-752-0041
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-23
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications