Provider Demographics
NPI:1487690798
Name:TANO, LEONEL (MD)
Entity type:Individual
Prefix:DR
First Name:LEONEL
Middle Name:
Last Name:TANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 781567
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78278-1567
Mailing Address - Country:US
Mailing Address - Phone:210-227-9408
Mailing Address - Fax:210-223-0626
Practice Address - Street 1:711 WEST KIRK PL.
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78226-1416
Practice Address - Country:US
Practice Address - Phone:210-227-9408
Practice Address - Fax:210-223-0626
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE7516208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1120941-04Medicaid
0009KPOtherBLUE CROSS BLUE SHIELD GR
TX168296501Medicaid
TX1120941-01Medicaid
TX1120941-02Medicaid
TX8K1570OtherBLUE CROSS BLUE SHEIDL TX ID#
8K1570OtherBLUE CROSS BLUE SHIELD
TX1120941-03Medicaid
C22480Medicare UPIN
TX0009KPMedicare PIN
TX168296501Medicaid
TX1120941-02Medicaid
TX1120941-04Medicaid