Provider Demographics
NPI:1043586746
Name:HENRY LEPELY MD PA
Entity Type:Organization
Organization Name:HENRY LEPELY MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEPELY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-737-1300
Mailing Address - Street 1:4131 UNIVERSITY BLVD S STE 7
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-4346
Mailing Address - Country:US
Mailing Address - Phone:904-737-1300
Mailing Address - Fax:904-737-9007
Practice Address - Street 1:4131 UNIVERSITY BLVD S STE 7
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4346
Practice Address - Country:US
Practice Address - Phone:904-737-1300
Practice Address - Fax:904-737-9007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME549432084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL048191200Medicaid
FL048191200Medicaid