Provider Demographics
NPI:1073560124
Name:JOVEL, LUIS ANTONIO (MD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:ANTONIO
Last Name:JOVEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14690 SPRING HILL DR
Mailing Address - Street 2:SUITE 100 ATTN:CREDENTIALING
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-8102
Mailing Address - Country:US
Mailing Address - Phone:352-799-0046
Mailing Address - Fax:352-606-2857
Practice Address - Street 1:2323 1ST AVE N
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-8818
Practice Address - Country:US
Practice Address - Phone:727-327-5188
Practice Address - Fax:727-321-3728
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0064801207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01438917OtherRAILROAD MEDICARE
FL375689100Medicaid
FLP01438917OtherRAILROAD MEDICARE
FL25628SMedicare PIN
FL25628VMedicare PIN
FL375689100Medicaid
FL25628AMedicare PIN
FL25628UMedicare PIN