Healthcare Provider Details

I. General information

NPI: 1275539199
Provider Name (Legal Business Name): LEONCIO F ESPIRITU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 06/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5305 GULF DR STE 4
NEW PORT RICHEY FL
34652-3960
US

IV. Provider business mailing address

5305 GULF DR STE 4
NEW PORT RICHEY FL
34652-3960
US

V. Phone/Fax

Practice location:
  • Phone: 727-847-0848
  • Fax: 727-849-4876
Mailing address:
  • Phone: 727-847-0848
  • Fax: 727-849-4876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberME42645
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: