Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0505X | Family Doctor - Adult Medicine | 11013617 | FL |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 11013617 | FL |
NPI | 1073182085 |
---|---|
Provider Name | Michael St Leger |
First Address | Ocala, FL 34471-2913 |
Second Address | Ocala, FL 34471-2913 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2021 |
Last Update Date | 23/06/2021 |