Healthcare Provider Details

I. General information

NPI: 1306003025
Provider Name (Legal Business Name): DANIEL KESSLER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2008
Last Update Date: 07/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9759 SAN JOSE BLVD BUILDING 2
JACKSONVILLE FL
32257-4401
US

IV. Provider business mailing address

PO BOX 551308
JACKSONVILLE FL
32255-1308
US

V. Phone/Fax

Practice location:
  • Phone: 904-622-9035
  • Fax: 904-493-2222
Mailing address:
  • Phone: 904-622-9035
  • Fax: 904-493-2222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS10198
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: