Healthcare Provider Details

I. General information

NPI: 1053366880
Provider Name (Legal Business Name): THE DOCTORS CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 09/20/2024
Certification Date: 09/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9857 OLD SAINT AUGUSTINE RD STE 1
JACKSONVILLE FL
32257-8821
US

IV. Provider business mailing address

9857 OLD SAINT AUGUSTINE RD STE 1
JACKSONVILLE FL
32257-8821
US

V. Phone/Fax

Practice location:
  • Phone: 904-861-1900
  • Fax: 904-292-9684
Mailing address:
  • Phone: 904-861-1900
  • Fax: 904-292-9684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID ROMANELLO
Title or Position: COO
Credential:
Phone: 352-459-3661