MEDICARE: DR. LEON IRA GILNER 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	207T00000X	Neurological Surgery Physician	J7497	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8A0022	OTHER	TX	BLUE CROSS

General Provider Information

NPI Number	:	1295738730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEON IRA GILNER M.D.

Provider Business Mailing Address
First Line	:	1940 W SPIRIT CT
Second Line	:
City	:	ANTHEM
State	:	AZ
Zip	:	85086-1829
Country	:	US
Telephone Number	:	623-374-2521
Fax Number	:	623-374-7081

Provider Business Practice Location Address
First Line	:	605 E SAN ANTONIO ST
Second Line	:	SUITE 510E
City	:	VICTORIA
State	:	TX
Zip	:	77901-6050
Country	:	US
Telephone Number	:	623-374-2521
Fax Number	:	623-374-7081

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

Provider Enumeration Date	:	05/28/2005
Last Update Date	:	06/20/2011

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