Individual
DR. GUILLERMO P PONCE DE LEON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7777 SOUTHWEST FWY, SUITE 810, HOUSTON, TX 77074-1802
(713) 772-1200
(713) 772-0258
Mailing address
13811 MURPHY RD, STAFFORD, TX 77477-4903
(713) 772-1200
(713) 772-0258
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
J4446
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1001101217
AMERIGROUP
TX
05
—
1376204-03
—
TX
01
—
20038447
MEDICARE RR
TX
01
—
4722236
CIGNA
TX
01
—
5908117
AETNA
TX
Enumeration date
10/04/2006
Last updated
06/14/2021
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