Provider Demographics
NPI:1649304973
Name:J. LEONARD MORILLO, M.D. P.A.
Entity type:Organization
Organization Name:J. LEONARD MORILLO, M.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:J.
Authorized Official - Middle Name:LEONARD
Authorized Official - Last Name:MORILLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-363-7979
Mailing Address - Street 1:8809 COMMODITY CIR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-9052
Mailing Address - Country:US
Mailing Address - Phone:407-363-7979
Mailing Address - Fax:407-355-9816
Practice Address - Street 1:8809 COMMODITY CIR
Practice Address - Street 2:SUITE 1
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-9052
Practice Address - Country:US
Practice Address - Phone:407-363-7979
Practice Address - Fax:407-355-9816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL45121207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL51264Medicare ID - Type Unspecified
FLC67060Medicare UPIN