MEDICARE: JSPEELE, MD, INC

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	261Q00000X	Clinic/Center	ME61635	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	43697	OTHER	FL	BC/BS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548507908
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JSPEELE, MD, INC

Provider Business Mailing Address
First Line	:	7380 W SAND LAKE RD
Second Line	:	SUITE 500
City	:	ORLANDO
State	:	FL
Zip	:	32819-5248
Country	:	US
Telephone Number	:	407-929-5611
Fax Number	:	888-253-9194

Provider Business Practice Location Address
First Line	:	7380 W SAND LAKE RD
Second Line	:	SUITE 500
City	:	ORLANDO
State	:	FL
Zip	:	32819-5248
Country	:	US
Telephone Number	:	407-929-5611
Fax Number	:	888-253-9194

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JEFFREY S PEELE
Credential	:	MD
Telephone Number	:	407-929-5611

Provider Enumeration Date	:	01/05/2013
Last Update Date	:	01/05/2013

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