Healthcare Provider Details

I. General information

NPI: 1831117092
Provider Name (Legal Business Name): PHILIPP ROQUE ALDANA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 10/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

836 PRUDENTIAL DR UFJP PEDIATRIC NEUROSURGERY CENTER
JACKSONVILLE FL
32207-8334
US

IV. Provider business mailing address

PO BOX 44008 UFJP PROVIDER ENROLLMENT
JACKSONVILLE FL
32231-4008
US

V. Phone/Fax

Practice location:
  • Phone: 904-398-5201
  • Fax: 904-398-8838
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberME70228
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: