MEDICARE: DR. LEONARDO SISON DELROSARIO 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	207QG0300X	Geriatric Medicine (Family Medicine) Physician	ME27959	FL

General Provider Information

NPI Number	:	1518934272
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEONARDO SISON DELROSARIO M.D.

Provider Business Mailing Address
First Line	:	225 W ASHLEY ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32202-4141
Country	:	US
Telephone Number	:	904-354-3885
Fax Number	:	904-356-8648

Provider Business Practice Location Address
First Line	:	225 W ASHLEY ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32202-4141
Country	:	US
Telephone Number	:	904-354-3885
Fax Number	:	904-356-8648

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

Provider Enumeration Date	:	03/01/2006
Last Update Date	:	07/08/2007

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