Individual
LEONCIO S DIZON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
390 MAPLE SUMMIT RD, JERSEYVILLE, IL 62052
(618) 498-7518
(618) 498-3052
Mailing address
390 MAPLE SUMMIT RD, JERSEYVILLE, IL 62052-2000
(618) 498-7518
(618) 498-3052
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
036091652
IL
207R00000X
Internal Medicine Physician
Primary
036091652
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036091652
—
IL
01
—
110114535
MEDICARE RAILROAD
IL
Enumeration date
04/19/2006
Last updated
11/13/2024
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