Healthcare Provider Details

I. General information

NPI: 1427021591
Provider Name (Legal Business Name): LEIF A LOHRBAUER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4205 BELFORT RD SUITE 2069
JACKSONVILLE FL
32216-1471
US

IV. Provider business mailing address

4205 BELFORT RD SUITE 2069
JACKSONVILLE FL
32216-1471
US

V. Phone/Fax

Practice location:
  • Phone: 904-296-0278
  • Fax: 904-296-0279
Mailing address:
  • Phone: 904-296-0278
  • Fax: 904-296-0279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME12983
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: