MEDICARE: ISIDRO G DELEON DO PA

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	207Q00000X	Family Medicine Physician	K7714	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	5658340001	OTHER	TX	MEDICARE NSC
4	00515R	OTHER	TX	MEDICARE
5	CH7975	OTHER	TX	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	00515R	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1528001526
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ISIDRO G DELEON DO PA

Provider Business Mailing Address
First Line	:	826 S MEYER ST
Second Line	:
City	:	SEALY
State	:	TX
Zip	:	77474-3433
Country	:	US
Telephone Number	:	979-627-0795
Fax Number	:	979-627-0799

Provider Business Practice Location Address
First Line	:	826 S MEYER ST
Second Line	:
City	:	SEALY
State	:	TX
Zip	:	77474-3433
Country	:	US
Telephone Number	:	979-627-0795
Fax Number	:	979-627-0799

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	ISIDRO G DE LEON
Credential	:	D.O.
Telephone Number	:	979-627-0795

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	08/31/2010

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Directions to “ISIDRO G DELEON DO PA ” Practice Location

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