Healthcare Provider Details

I. General information

NPI: 1407921497
Provider Name (Legal Business Name): LEON CRAIG MCASKILL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2006
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:
Title or Position:
Credential:
Phone: