Provider Demographics
NPI:1699773226
Name:ANDRES, LEONIDAS S (MD)
Entity type:Individual
Prefix:DR
First Name:LEONIDAS
Middle Name:S
Last Name:ANDRES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:538 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:WINNIE
Mailing Address - State:TX
Mailing Address - Zip Code:77665-7600
Mailing Address - Country:US
Mailing Address - Phone:409-296-6000
Mailing Address - Fax:409-396-6372
Practice Address - Street 1:538 BROADWAY
Practice Address - Street 2:
Practice Address - City:WINNIE
Practice Address - State:TX
Practice Address - Zip Code:77665-7600
Practice Address - Country:US
Practice Address - Phone:409-296-6000
Practice Address - Fax:409-396-6372
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2024-07-25
Deactivation Date:2006-03-29
Deactivation Code:
Reactivation Date:2006-03-29
Provider Licenses
StateLicense IDTaxonomies
TXF3714207Q00000X, 207P00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX139871124Medicaid
TX80A578OtherMEDICARE PTAN
TX80A578OtherMEDICARE PTAN
TX139871124Medicaid