MEDICARE: DR. ANTHONY JOSEPH LEONCAVALLO M.D.

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	207W00000X	Ophthalmology Physician	ME112668	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992954259
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANTHONY JOSEPH LEONCAVALLO M.D.

Provider Business Mailing Address
First Line	:	2800 ROSS CLARK CIR
Second Line	:
City	:	DOTHAN
State	:	AL
Zip	:	36301-2040
Country	:	US
Telephone Number	:	334-793-2211
Fax Number	:	334-793-7161

Provider Business Practice Location Address
First Line	:	9657 US HIGHWAY 98 W
Second Line	:
City	:	MIRAMAR BEACH
State	:	FL
Zip	:	32550-7273
Country	:	US
Telephone Number	:	850-650-6550
Fax Number	:	850-650-6540

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

Provider Enumeration Date	:	09/11/2008
Last Update Date	:	03/18/2014

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