MEDICARE: LEO BRAZEAU PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA1894	FL

General Provider Information

NPI Number	:	1114912938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEO BRAZEAU PA

Provider Business Mailing Address
First Line	:	7056 MARINER BLVD
Second Line	:
City	:	SPRING HILL
State	:	FL
Zip	:	34609-1000
Country	:	US
Telephone Number	:	352-597-5557
Fax Number	:	352-597-0552

Provider Business Practice Location Address
First Line	:	7056 MARINER BLVD
Second Line	:
City	:	SPRING HILL
State	:	FL
Zip	:	34609-1000
Country	:	US
Telephone Number	:	352-597-5557
Fax Number	:	352-597-0552

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/19/2005
Last Update Date	:	07/08/2007

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Directions to “ LEO BRAZEAU PA” Practice Location

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