Basic Information
| Provider Information | |||||||||
| NPI: | 1831132638 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NEVILLE | ||||||||
| FirstName: | LEAHA | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | DPM | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 112727 | ||||||||
| Address2: | UF ORTHOPEDICS AND SPORTS MEDICINE INSTITUTE | ||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522737394 | ||||||||
| FaxNumber: | 3522737388 | ||||||||
| Practice Location | |||||||||
| Address1: | 49 8TH ST N | ||||||||
| Address2: | |||||||||
| City: | NAPLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 341026020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2394361999 | ||||||||
| FaxNumber: | 2364363788 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2006 | ||||||||
| LastUpdateDate: | 07/12/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0103X | PO3148 | FL | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery | 213E00000X | PO3148 | FL | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist |
ID Information
| ID | Type | State | Issuer | Description | 020786800 | 05 | FL | MEDICAID | U7945Y | 01 | MEDICARE PTAN | OTHER |