Provider Demographics
NPI:1376696963
Name:JORGE J. LEAL, M.D., LLC.
Entity Type:Organization
Organization Name:JORGE J. LEAL, M.D., LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-333-0647
Mailing Address - Street 1:4710 N HABANA AVE
Mailing Address - Street 2:SUITE 407
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-7161
Mailing Address - Country:US
Mailing Address - Phone:813-333-0647
Mailing Address - Fax:813-514-8620
Practice Address - Street 1:4710 N HABANA AVE
Practice Address - Street 2:SUITE 407
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-7161
Practice Address - Country:US
Practice Address - Phone:813-333-0647
Practice Address - Fax:813-514-8620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK9289Medicare ID - Type Unspecified