Healthcare Provider Details

I. General information

NPI: 1336148964
Provider Name (Legal Business Name): TODD J RASNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11945 SAN JOSE BLVD BLD 400
JACKSONVILLE FL
32223-1613
US

IV. Provider business mailing address

11945 SAN JOSE BLVD BLD 400
JACKSONVILLE FL
32223-1613
US

V. Phone/Fax

Practice location:
  • Phone: 904-262-5333
  • Fax:
Mailing address:
  • Phone: 904-262-5333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberME66731
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: