Provider Demographics
NPI:1881721801
Name:LEONG, HERMAN G (MD)
Entity type:Individual
Prefix:
First Name:HERMAN
Middle Name:G
Last Name:LEONG
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 1:117 MEDICAL DR
Mailing Address - Street 2:STE 1
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-3114
Mailing Address - Country:US
Mailing Address - Phone:361-573-4331
Mailing Address - Fax:361-573-5096
Practice Address - Street 1:117 MEDICAL DR
Practice Address - Street 2:SUITE 1
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-3102
Practice Address - Country:US
Practice Address - Phone:361-573-4331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP2718207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H78203Medicare UPIN