Healthcare Provider Details

I. General information

NPI: 1699072256
Provider Name (Legal Business Name): PERI M. SERT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2011
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4348 SOUTHPOINT BLVD STE 100
JACKSONVILLE FL
32216-0903
US

IV. Provider business mailing address

4348 SOUTHPOINT BLVD STE 100
JACKSONVILLE FL
32216-0903
US

V. Phone/Fax

Practice location:
  • Phone: 904-281-1915
  • Fax:
Mailing address:
  • Phone: 904-281-1915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME107104
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME107104
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: