MEDICARE: DR. HENRY LEPELY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	ME0054943	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083643175
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HENRY LEPELY M.D.

Provider Business Mailing Address
First Line	:	4131 UNIVERSITY BLVD S
Second Line	:	BLDG 7
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-4326
Country	:	US
Telephone Number	:	904-737-1300
Fax Number	:	904-737-9007

Provider Business Practice Location Address
First Line	:	4131 UNIVERSITY BLVD S
Second Line	:	BLDG 7
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-4326
Country	:	US
Telephone Number	:	904-737-1300
Fax Number	:	904-737-9007

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2006
Last Update Date	:	07/02/2010

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