| Doctor Name: | DR. JERRY LEVENTHAL |
| NPI Number: | 1558364265 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | ME69470 |
| Business Practice Address: | 21 Hospital Drive Ste 280 Palm Coast, FL - 32164 |
| Business Phone Number: | 3864374711 |
| Business Fax Number: | 3864374772 |
| Mailing Address: | 21 Hospital Dr, Ste 280 PALM COAST |
| State: | FL |
| Postal Code: | 321642452 |
| Phone Number: | 3864374711 |
| Fax Number: | 3867675580 |
| NPI Enumeration Date: | 05/27/2005 |
| NPI Last Update Date: | 04/13/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | ME69470 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | FL |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |