Provider Demographics
NPI:1073624649
Name:MAYLE, LOVELL LEONARD (MD)
Entity Type:Individual
Prefix:DR
First Name:LOVELL
Middle Name:LEONARD
Last Name:MAYLE
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 1:15705 PANTHER LAKE DR
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-4567
Mailing Address - Country:US
Mailing Address - Phone:352-223-0061
Mailing Address - Fax:
Practice Address - Street 1:17000 PORTER RD
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-8915
Practice Address - Country:US
Practice Address - Phone:321-842-5052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME59012207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL271321700Medicaid
FL11640OtherBLUE CROSS BLUE SHIELD
FL11640OtherBLUE CROSS BLUE SHIELD