Healthcare Provider Details

I. General information

NPI: 1801943980
Provider Name (Legal Business Name): BRETT BENNETT CANTRELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 12/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SHIRCLIFF WAY DEPT OF PATHOLOGY
JACKSONVILLE FL
32204-4748
US

IV. Provider business mailing address

PO BOX 144333
ORLANDO FL
32814-4333
US

V. Phone/Fax

Practice location:
  • Phone: 904-308-3804
  • Fax: 904-308-2970
Mailing address:
  • Phone: 407-422-9831
  • Fax: 407-206-1767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License NumberME36574
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: