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1194787838

NPI Code Detail

MEDICARE: JORGE J LEAL MD

MEDICARE: JORGE J LEAL MD

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	207L00000X	Anesthesiology Physician	ME61327	FL
2	207LP2900X	Pain Medicine (Anesthesiology) Physician	ME61327	FL
3	208VP0014X	Interventional Pain Medicine Physician	ME61327	FL
4	208VP0000X	Pain Medicine Physician	ME61327	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	:	1194787838
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORGE J LEAL MD

Provider Business Mailing Address
First Line	:	4730 N HABANA AVE
Second Line	:	STE 204
City	:	TAMPA
State	:	FL
Zip	:	33614-7163
Country	:	US
Telephone Number	:	813-549-2134
Fax Number	:	813-864-4436

Provider Business Practice Location Address
First Line	:	4730 N HABANA AVE STE 104
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614-7165
Country	:	US
Telephone Number	:	813-739-7498
Fax Number	:	813-864-0788

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

Provider Enumeration Date	:	04/06/2006
Last Update Date	:	07/21/2022

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Directions to “ JORGE J LEAL MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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