Healthcare Provider Details

I. General information

NPI: 1134345846
Provider Name (Legal Business Name): WALTER LEON, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 02/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3120 MATLOCK RD STE 201
ARLINGTON TX
76015-2903
US

IV. Provider business mailing address

3120 MATLOCK RD STE 201
ARLINGTON TX
76015-2903
US

V. Phone/Fax

Practice location:
  • Phone: 817-467-0889
  • Fax: 817-557-4676
Mailing address:
  • Phone: 817-467-0889
  • Fax: 817-557-4676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: SHELLEY GARDNER
Title or Position: OFFICE MANAGER
Credential:
Phone: 817-467-0889