Provider Demographics
NPI:1841272556
Name:LEAL, ROLANDO J (MD)
Entity type:Individual
Prefix:DR
First Name:ROLANDO
Middle Name:J
Last Name:LEAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1324 WOLF PARK DR
Mailing Address - Street 2:SUITE 38138
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-1741
Mailing Address - Country:US
Mailing Address - Phone:901-755-9110
Mailing Address - Fax:901-755-4321
Practice Address - Street 1:1324 WOLF PARK DR
Practice Address - Street 2:SUITE 38138
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-1741
Practice Address - Country:US
Practice Address - Phone:901-755-9110
Practice Address - Fax:901-755-4321
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-17
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TNMD024629207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3077333Medicare ID - Type Unspecified
TNE97732Medicare UPIN