MEDICARE: DR. STACY LEON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	J4299	TX
2	2084P0804X	Child & Adolescent Psychiatry Physician	J4299	TX

General Provider Information

NPI Number	:	1215213442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STACY LEON M.D.

Provider Business Mailing Address
First Line	:	2630 EXPOSITION BLVD
Second Line	:	SUITE 116
City	:	AUSTIN
State	:	TX
Zip	:	78703-1700
Country	:	US
Telephone Number	:	512-474-2488
Fax Number	:	512-474-2824

Provider Business Practice Location Address
First Line	:	2630 EXPOSITION BLVD
Second Line	:	SUITE 116
City	:	AUSTIN
State	:	TX
Zip	:	78703-1700
Country	:	US
Telephone Number	:	512-474-2488
Fax Number	:	512-474-2824

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2011
Last Update Date	:	11/02/2011

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Directions to “ DR. STACY LEON M.D.” Practice Location

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