MEDICARE: DR. JEAN MARIE DELEON 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	208100000X	Physical Medicine & Rehabilitation Physician	J4074	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8F8835	OTHER	TX	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720002793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEAN MARIE DELEON M.D.

Provider Business Mailing Address
First Line	:	3504 SWISS AVE
Second Line	:	SUITE 100
City	:	DALLAS
State	:	TX
Zip	:	75204-6224
Country	:	US
Telephone Number	:	214-820-9895
Fax Number	:	214-820-9689

Provider Business Practice Location Address
First Line	:	3504 SWISS AVE
Second Line	:	SUITE 100
City	:	DALLAS
State	:	TX
Zip	:	75204-6224
Country	:	US
Telephone Number	:	214-820-9895
Fax Number	:	214-820-9689

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

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	05/12/2011

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