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General NPI Number Information
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NPI Number | 1003024944
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Entity Type | Individual
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Provider Name | JOSE L DE LEON P.A.-C.
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Gender | Male
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Dates
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Enumeration Date | 05/21/2007
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Last Update Date | 04/17/2025
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Provider Practice Location Address
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Address Line | 800 MEDICAL CENTER DR STE C
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City | DECATUR
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State | TX
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Zip | 76234-3844
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Country | US
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Telephone | 940-626-2110
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Fax |
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Provider Business Mailing Address
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Address Line | 363 TEJAS TRL
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City | SPRINGTOWN
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State | TX
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Zip | 76082-4715
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Country | US
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Telephone | 248-245-7948
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA02223
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License Number State | TX
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