Provider Demographics
NPI:1821023268
Name:DE LEON, HECTOR M (MD)
Entity Type:Individual
Prefix:DR
First Name:HECTOR
Middle Name:M
Last Name:DE LEON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1799 SALK AVE
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-4311
Mailing Address - Country:US
Mailing Address - Phone:352-742-8300
Mailing Address - Fax:352-742-8305
Practice Address - Street 1:1799 SALK AVE
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-4311
Practice Address - Country:US
Practice Address - Phone:352-742-8300
Practice Address - Fax:352-742-8305
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME891642084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL267132OtherWELLCARE / HEALTHEASE
FL37905OtherBLUE CROSS & BLUE SHIELD
FLH06824Medicare UPIN
FL37905ZMedicare ID - Type Unspecified