Provider Demographics
NPI:1235485608
Name:MESA, LEOCAR (MD)
Entity Type:Individual
Prefix:
First Name:LEOCAR
Middle Name:
Last Name:MESA
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 1:7350 SANDLAKE COMMONS BLVD
Mailing Address - Street 2:SUITE 1102
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-8040
Mailing Address - Country:US
Mailing Address - Phone:321-843-5500
Mailing Address - Fax:321-843-5550
Practice Address - Street 1:7350 SANDLAKE COMMONS BLVD
Practice Address - Street 2:SUITE 1102
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-8040
Practice Address - Country:US
Practice Address - Phone:321-843-5500
Practice Address - Fax:321-843-5550
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-03
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME113833207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine