Provider Demographics
NPI:1437388907
Name:LEON, JOSE AGUSTIN (MD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:AGUSTIN
Last Name:LEON
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:JOSE
Other - Middle Name:AGUSTIN
Other - Last Name:LEON DE LA ROCHA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2015 2ND AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29486-7889
Mailing Address - Country:US
Mailing Address - Phone:843-793-6980
Mailing Address - Fax:
Practice Address - Street 1:1907 S COLLEGE ST STE 201
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36832-5906
Practice Address - Country:US
Practice Address - Phone:334-203-6196
Practice Address - Fax:334-275-4461
Is Sole Proprietor?:No
Enumeration Date:2009-07-06
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL31742207RR0500X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL140663Medicaid