Individual
JUAN JOSE LEON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
777 HOSPITAL WAY, PORTNEUF HEART AND VASCULAR, POCATELLO, ID 83201
(208) 239-2500
Mailing address
777 HOSPITAL WAY, PORTNEUF HEART AND VASCULAR, POCATELLO, ID 83201
(208) 239-2500
Taxonomy
Speciality
Code
Description
License number
State
207LC0200X
Critical Care Medicine (Anesthesiology) Physician
Primary
TL3685
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807356000
—
ID
Enumeration date
04/18/2006
Last updated
11/03/2022
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