Provider Demographics
NPI:1548507908
Name:JSPEELE, MD, INC
Entity type:Organization
Organization Name:JSPEELE, MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:S
Authorized Official - Last Name:PEELE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-929-5611
Mailing Address - Street 1:7380 W SAND LAKE RD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-5248
Mailing Address - Country:US
Mailing Address - Phone:407-929-5611
Mailing Address - Fax:888-253-9194
Practice Address - Street 1:7380 W SAND LAKE RD
Practice Address - Street 2:SUITE 500
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-5248
Practice Address - Country:US
Practice Address - Phone:407-929-5611
Practice Address - Fax:888-253-9194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-05
Last Update Date:2013-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME61635261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL43697OtherBC/BS
FL254676100Medicaid
FL43697WMedicare PIN
FL254676100Medicaid