Provider Demographics
NPI:1356762405
Name:LEAL, JOHN (NP)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:LEAL
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 53666
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79710-3666
Mailing Address - Country:US
Mailing Address - Phone:210-568-5816
Mailing Address - Fax:210-399-4637
Practice Address - Street 1:13423 BLANCO RD # 8046
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-2187
Practice Address - Country:US
Practice Address - Phone:210-568-5816
Practice Address - Fax:210-399-4637
Is Sole Proprietor?:No
Enumeration Date:2013-12-16
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX677625363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily