Healthcare Provider Details

I. General information

NPI: 1679897466
Provider Name (Legal Business Name): CERES LIM ROXAS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2010
Last Update Date: 03/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N MAIN ST
CHATTAHOOCHEE FL
32324-1107
US

IV. Provider business mailing address

10360 HUNTINGTON FOREST BLVD E
JACKSONVILLE FL
32257-7620
US

V. Phone/Fax

Practice location:
  • Phone: 850-663-7501
  • Fax: 850-663-7771
Mailing address:
  • Phone: 904-699-0605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME32140
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: