Healthcare Provider Details

I. General information

NPI: 1013375195
Provider Name (Legal Business Name): DUVAL VASCULAR CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2016
Last Update Date: 09/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 W MONROE ST SUITE 100
JACKSONVILLE FL
32204-1177
US

IV. Provider business mailing address

3001 PALM HARBOR BLVD STE A
PALM HARBOR FL
34683-1930
US

V. Phone/Fax

Practice location:
  • Phone: 904-518-1398
  • Fax: 904-513-0231
Mailing address:
  • Phone: 727-474-0090
  • Fax: 727-474-0055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JANET R. DEES
Title or Position: MANAGING MEMBER
Credential:
Phone: 727-474-0090