Individual
DR. DIANE M ICENOGLE LEUSCHEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
7400 MERTON MINTER, SAN ANTONIO, TX 78229-4404
(210) 617-5300
(210) 949-3350
Mailing address
7400 MERTON MINTER, SAN ANTONIO, TX 78229-4404
(210) 617-5300
(210) 949-3350
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
J8600
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8D8214
MEDICARE ID - TYPE UNSPECIFIED
TX
01
—
J8600
MEDICAL LICENSE
TX
Enumeration date
12/22/2005
Last updated
10/14/2009
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