Active NPI
Jose Antonio Elizondo Leal, M.D.
- Pediatrics Physician
- Roswell, NM
National Provider Identifier
1801477435
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- MD2024-0181
- Practice address
- 813 N. Washington Ave
Roswell, NM 88201 - Phone
- (575) 622-2606
- Fax
- (575) 622-6645
- NPI assigned
- Apr 15, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | MD2024-0181 | NM | Primary |
Addresses
Primary practice location
813 N. Washington Ave
Roswell, NM 88201
Mailing address
813 N. Washington Ave
Roswell, NM 88201
Phone (575) 622-2606
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD2024-0181 | NM | MD | Pediatrics Physician |
Interoperability endpoints
- elizondo@bca.pcc-direct.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1618444800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1719446400000",
"number": "1801477435",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "813 N. WASHINGTON AVE",
"city": "ROSWELL",
"state": "NM",
"postal_code": "88201",
"telephone_number": "575-622-2606",
"fax_number": "575-622-6645"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "813 N. WASHINGTON AVE",
"city": "ROSWELL",
"state": "NM",
"postal_code": "88201",
"telephone_number": "575-622-2606",
"fax_number": "575-622-6645"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELIZONDO LEAL",
"first_name": "JOSE ANTONIO",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-04-15",
"last_updated": "2024-06-27",
"certification_date": "2024-06-27",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NM",
"license": "MD2024-0181",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Roswell, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.