=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306864145
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LEO GASTON STINNETT JR. MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/18/2006
-----------------------------------------------------
Last Update Date | 04/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1209 W TARGET RANGE RD
-----------------------------------------------------
City | NOGALES
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85621-2466
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-287-4747
-----------------------------------------------------
Fax | 520-285-3136
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1189 E MADERA ESTATES LN
-----------------------------------------------------
City | SAHUARITA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85629-6687
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-332-1260
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | J0285
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | 27159
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------