Provider Demographics
NPI:1417947961
Name:SHVARTZMAN, LEONARD A (MD)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:A
Last Name:SHVARTZMAN
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 1:1550 RIVERSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-4161
Mailing Address - Country:US
Mailing Address - Phone:904-923-6647
Mailing Address - Fax:
Practice Address - Street 1:1550 RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-4161
Practice Address - Country:US
Practice Address - Phone:904-613-3966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME76595207ND0101X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL43988ZMedicare ID - Type Unspecified
FLG77179Medicare UPIN