Provider Demographics
NPI:1518969112
Name:MCLEOD, ELIZABETH K (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:K
Last Name:MCLEOD
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1400 US HIGHWAY 1 S
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084-4211
Mailing Address - Country:US
Mailing Address - Phone:904-829-2286
Mailing Address - Fax:904-810-5687
Practice Address - Street 1:3020 HARTLEY RD STE 190
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257
Practice Address - Country:US
Practice Address - Phone:904-292-2020
Practice Address - Fax:904-292-2044
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2018-06-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME49052207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
11803UMedicare ID - Type UnspecifiedMEDICARE NUMBER
E75900Medicare UPIN