Provider Demographics
NPI:1942236856
Name:DE LEON, ISIDRO G (DO)
Entity Type:Individual
Prefix:
First Name:ISIDRO
Middle Name:G
Last Name:DE LEON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:826 S MEYER ST
Mailing Address - Street 2:
Mailing Address - City:SEALY
Mailing Address - State:TX
Mailing Address - Zip Code:77474-3433
Mailing Address - Country:US
Mailing Address - Phone:979-627-0795
Mailing Address - Fax:979-627-0799
Practice Address - Street 1:826 S MEYER ST.
Practice Address - Street 2:
Practice Address - City:SEALY
Practice Address - State:TX
Practice Address - Zip Code:77474-3433
Practice Address - Country:US
Practice Address - Phone:979-627-0795
Practice Address - Fax:979-627-0799
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7714207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX144736901Medicaid
TXP00140711OtherRAILROAD MEDICARE
TX5658340001OtherMEDICARE NSC
TX8123N0OtherBCBS
TX8123N0OtherMEDICARE
TXP00140711OtherRAILROAD MEDICARE