Provider Demographics
NPI:1295058295
Name:PABLO LEONARDO MD PA
Entity type:Organization
Organization Name:PABLO LEONARDO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:PABLO
Authorized Official - Middle Name:
Authorized Official - Last Name:LEONARDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:254-526-0404
Mailing Address - Street 1:2301 S CLEAR CREEK RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76549-4143
Mailing Address - Country:US
Mailing Address - Phone:254-526-0404
Mailing Address - Fax:254-526-9673
Practice Address - Street 1:2301 S CLEAR CREEK RD
Practice Address - Street 2:SUITE 202
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76549-4143
Practice Address - Country:US
Practice Address - Phone:254-526-0404
Practice Address - Fax:254-526-9673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-04
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG1945207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC18334Medicare UPIN