Provider Demographics
NPI:1912905902
Name:LEPPERT, HOLLACE D (DO)
Entity type:Individual
Prefix:
First Name:HOLLACE
Middle Name:D
Last Name:LEPPERT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2675 WINKLER AVE
Mailing Address - Street 2:FL 2
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9342
Mailing Address - Country:US
Mailing Address - Phone:239-931-3440
Mailing Address - Fax:
Practice Address - Street 1:3571 DEL PRADO BLVD N
Practice Address - Street 2:SUITE 2
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33909-5286
Practice Address - Country:US
Practice Address - Phone:239-656-6300
Practice Address - Fax:239-656-6765
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8674207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110241874OtherRR MEDICARE
FL265247100Medicaid
FL3059936OtherCIGNA
FL51988OtherBCBS
FL4636764OtherAETNA
FL4636764OtherAETNA
FLF09017Medicare UPIN