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NPI Code Detail

MEDICARE: LEONARD JOEL SPILLERT M.D.

MEDICARE: LEONARD JOEL SPILLERT 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
1208D00000XGeneral Practice PhysicianME17473FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
171614OTHERFLBCBS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1326007139
Entity Type Code : Individual
Provider Name (Legal Business Name) : LEONARD JOEL SPILLERT M.D.
Provider Business Mailing Address
First Line : 4217 BAYMEADOWS RD
Second Line : SUITE 3
City : JACKSONVILLE
State : FL
Zip : 32217-4676
Country : US
Telephone Number : 904-332-7431
Fax Number : 904-332-7408
Provider Business Practice Location Address
First Line : 4217 BAYMEADOWS RD
Second Line : SUITE 3
City : JACKSONVILLE
State : FL
Zip : 32217-4676
Country : US
Telephone Number : 904-332-7431
Fax Number : 904-332-7408
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/21/2006
Last Update Date : 09/05/2013

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