Healthcare Provider Details
I. General information
NPI: 1528336575
Provider Name (Legal Business Name): VPA PC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 12/06/2011
Last Update Date: 03/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
4348 SOUTHPOINT BLVD SUITE 100
JACKSONVILLE FL
32216-0986
US
IV. Provider business mailing address
PO BOX 1239
TROY MI
48099-1239
US
V. Phone/Fax
- Phone: 904-281-1915
- Fax: 904-281-1119
- Phone: 248-824-6600
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 207R00000X |
| Taxonomy | Internal Medicine Physician |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207Q00000X |
| Taxonomy | Family Medicine Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: DR.
WILLIAM
F
SASSER
JR.
Title or Position: OWNER
Credential: MD
Phone: 248-824-6000