Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | J1167 | TX |
NPI | 1639255896 |
---|---|
Provider Name | Dr. Rene Albert Leon |
First Address | Southlake, TX 76092-6376 |
Second Address | Southlake, TX 76092-6375 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2006 |
Last Update Date | 30/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F65066 | (02) | TX |