Organization
JORGE J LEAL MD UROLOGIST LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JORGE J. LEAL M.D. (PRESIDENT)
(321) 452-2563
Entity
Organization
Contact information
Practice address
825 N COURTENAY PKWY, MERRITT ISLAND, FL 32953-4652
(321) 452-2563
(321) 453-5841
Mailing address
825 N COURTENAY PKWY, MERRITT ISLAND, FL 32953-4652
(321) 452-2563
(321) 453-5841
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
ME29037
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05400
BLUE CROSS BLUE SHIELD
FL
01
—
1653673
CIGNA
—
01
—
406142183
RAIL ROAD MEDICARE
—
01
—
4104040
AETNA
—
Enumeration date
02/20/2007
Last updated
06/23/2016
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