Provider Demographics
NPI:1770840423
Name:DAVID LEONARD SALL, M.D. P.A.
Entity Type:Organization
Organization Name:DAVID LEONARD SALL, M.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:LEONARD
Authorized Official - Last Name:SALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-396-2273
Mailing Address - Street 1:1357 PALM AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-8432
Mailing Address - Country:US
Mailing Address - Phone:904-396-2273
Mailing Address - Fax:904-396-2507
Practice Address - Street 1:1357 PALM AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8432
Practice Address - Country:US
Practice Address - Phone:904-396-2273
Practice Address - Fax:904-396-2507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-19
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00154442084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL056606300Medicaid
FL056606300Medicaid
FL15326Medicare PIN