Provider Demographics
NPI:1083643175
Name:LEPELY, HENRY (MD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:
Last Name:LEPELY
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 1:4131 UNIVERSITY BLVD S
Mailing Address - Street 2:BLDG 7
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-4326
Mailing Address - Country:US
Mailing Address - Phone:904-737-1300
Mailing Address - Fax:904-737-9007
Practice Address - Street 1:4131 UNIVERSITY BLVD S
Practice Address - Street 2:BLDG 7
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4326
Practice Address - Country:US
Practice Address - Phone:904-737-1300
Practice Address - Fax:904-737-9007
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-01
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00549432084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL048191200Medicaid
FL09379Medicare ID - Type Unspecified
FLF10343Medicare UPIN