Healthcare Provider Details

I. General information

NPI: 1720272644
Provider Name (Legal Business Name): JOHN MORELLO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2007
Last Update Date: 12/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13111 ATLANTIC BLVD. STE 4
JACKSONVILLE FL
32225
US

IV. Provider business mailing address

2295 OCEANSIDE CT
ATLANTIC BEACH FL
32233-5957
US

V. Phone/Fax

Practice location:
  • Phone: 904-221-3100
  • Fax: 904-221-3107
Mailing address:
  • Phone: 904-704-1699
  • Fax: 904-247-2686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME63627
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberME63627
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207NI0002X
TaxonomyClinical & Laboratory Dermatological Immunology Physician
License NumberME63627
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License NumberME63627
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberME63627
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: