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NPI Code Detail

MEDICARE: LORI A LEASEBURGE MD

MEDICARE: LORI A LEASEBURGE 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
1207VX0000XObstetrics PhysicianME93918FL

Other Identifiers

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

General Provider Information

NPI Number : 1275628455
Entity Type Code : Individual
Provider Name (Legal Business Name) : LORI A LEASEBURGE MD
Provider Business Mailing Address
First Line : 1891 BEACH BLVD
Second Line : SUITE 200
City : JACKSONVILLE
State : FL
Zip : 32250-2644
Country : US
Telephone Number : 904-249-3743
Fax Number : 904-249-2047
Provider Business Practice Location Address
First Line : 1891 BEACH BLVD
Second Line : SUITE 200
City : JACKSONVILLE
State : FL
Zip : 32250-2644
Country : US
Telephone Number : 904-249-3743
Fax Number : 904-249-2047
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2006
Last Update Date : 11/01/2011

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Directions to “ LORI A LEASEBURGE MD” Practice Location

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