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General NPI Number Information
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NPI Number | 1063696995
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Entity Type | Individual
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Provider Name | JACK L LEFROCK M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/27/2007
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Last Update Date | 06/24/2020
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Provider Practice Location Address
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Address Line | 2020 ROSE ST #A
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City | SARASOTA
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State | FL
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Zip | 34239
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Country | US
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Telephone | 941-388-7469
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Fax | 941-706-1059
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Provider Business Mailing Address
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Address Line | 2020 ROSE ST #A
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City | SARASOTA
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State | FL
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Zip | 34239
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Country | US
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Telephone | 941-388-7469
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Fax | 941-706-1059
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME17169
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License Number State | FL
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