Provider Demographics
NPI:1972664076
Name:LEAL, ENRIQUE A (MD)
Entity Type:Individual
Prefix:DR
First Name:ENRIQUE
Middle Name:A
Last Name:LEAL
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 1:208 N MCKINNEY ST # 2
Mailing Address - Street 2:
Mailing Address - City:SWEENY
Mailing Address - State:TX
Mailing Address - Zip Code:77480-3404
Mailing Address - Country:US
Mailing Address - Phone:979-647-1265
Mailing Address - Fax:979-647-1270
Practice Address - Street 1:208 N MCKINNEY ST # 2
Practice Address - Street 2:
Practice Address - City:SWEENY
Practice Address - State:TX
Practice Address - Zip Code:77480-3404
Practice Address - Country:US
Practice Address - Phone:979-647-1265
Practice Address - Fax:979-647-1270
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8896207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8GR934OtherBCBS TX
TXP02287858OtherRR - MEDICARE
TX041706513Medicaid
TXP00197453OtherRAIL ROAD MEDICARE
TX0036GQOtherBLUE SHIELD