Healthcare Provider Details

I. General information

NPI: 1245598358
Provider Name (Legal Business Name): L CRAIG MCASKILL MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2012
Last Update Date: 02/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3527 TAMIAMI TRL UNIT E
PORT CHARLOTTE FL
33952-8128
US

IV. Provider business mailing address

PO BOX 494948
PORT CHARLOTTE FL
33949-4948
US

V. Phone/Fax

Practice location:
  • Phone: 941-206-5200
  • Fax: 941-206-3322
Mailing address:
  • Phone: 941-206-5200
  • Fax: 941-206-3322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME95034
License Number StateFL

VIII. Authorized Official

Name: LEON CRAIG MCASKILL
Title or Position: OWNER
Credential: MD
Phone: 941-206-5200