Individual
LORI A LEASEBURGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1891 BEACH BLVD, SUITE 200, JACKSONVILLE, FL 32250-2644
(904) 249-3743
(904) 249-2047
Mailing address
1891 BEACH BLVD, SUITE 200, JACKSONVILLE, FL 32250-2644
(904) 249-3743
(904) 249-2047
Taxonomy
Speciality
Code
Description
License number
State
207VX0000X
Obstetrics Physician
Primary
ME93918
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
273607100
—
FL
Enumeration date
10/04/2006
Last updated
11/01/2011
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