Individual provider · NPI-1

John Gerard Deleonibus Jr., PA-C

Physician Assistant, Surgical · Bryan, TX

NPI number1669034310
StatusActive
Last updated in NPPESDec 30, 2020

Details

NPI
1669034310
Entity type
Individual (NPI-1)
Name
John Gerard Deleonibus Jr.
Credential
PA-C
Sex
Male
Sole proprietor
Yes
Enumeration date
Jul 2, 2019
Certification date
Dec 30, 2020
Last updated
Dec 30, 2020

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
363AS0400X Physician Assistant, SurgicalPA14181TXYes
390200000X Student in an Organized Health Care Education/Training Program––

Practice location

2800 S Texas Ave Ste 102
Bryan, TX 77802-5361

Phone 443-758-6090

Mailing address

2800 S Texas Ave Ste 102
Bryan, TX 77802-5361

Phone 443-758-6090

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