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General NPI Number Information
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NPI Number | 1952638041
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Entity Type | Individual
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Provider Name | COURTLAND LEROY MUNROE M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/10/2009
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Last Update Date | 02/09/2017
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Provider Practice Location Address
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Address Line | 1210 W MAIN ST
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City | LEESBURG
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State | FL
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Zip | 34748-4935
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Country | US
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Telephone | 352-787-8489
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Fax |
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Provider Business Mailing Address
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Address Line | 918 ROLLING ACRES RD STE 1
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City | LADY LAKE
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State | FL
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Zip | 32159-5026
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Country | US
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Telephone | 352-787-8489
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Fax |
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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 | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | LL692
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License Number State | FL
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