Provider Demographics
NPI:1427021591
Name:LOHRBAUER, LEIF A (MD)
Entity Type:Individual
Prefix:DR
First Name:LEIF
Middle Name:A
Last Name:LOHRBAUER
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 1:4205 BELFORT RD
Mailing Address - Street 2:SUITE 2069
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-1471
Mailing Address - Country:US
Mailing Address - Phone:904-296-0278
Mailing Address - Fax:904-296-0279
Practice Address - Street 1:4205 BELFORT RD
Practice Address - Street 2:SUITE 2069
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-1471
Practice Address - Country:US
Practice Address - Phone:904-296-0278
Practice Address - Fax:904-296-0279
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME12983207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL74682OtherJCC GROUP ID#
FL052381000Medicaid
FLD85994Medicare UPIN
FL53437ZMedicare PIN