Healthcare Provider Details

I. General information

NPI: 1003024944
Provider Name (Legal Business Name): JOSE L DE LEON P.A.-C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 MEDICAL CENTER DR STE C
DECATUR TX
76234-3844
US

IV. Provider business mailing address

363 TEJAS TRL
SPRINGTOWN TX
76082-4715
US

V. Phone/Fax

Practice location:
  • Phone: 940-626-2110
  • Fax:
Mailing address:
  • Phone: 248-245-7948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA02223
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: