Healthcare Provider Details

I. General information

NPI: 1285262600
Provider Name (Legal Business Name): JOHN ERIC CEBAK DO, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JOHNNY CEBAK DO, PHD

II. Dates (important events)

Enumeration Date: 03/31/2020
Last Update Date: 08/25/2024
Certification Date: 08/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 SAN PABLO RD S
JACKSONVILLE FL
32224-1865
US

IV. Provider business mailing address

4500 SAN PABLO RD S
JACKSONVILLE FL
32224-1865
US

V. Phone/Fax

Practice location:
  • Phone: 904-953-2000
  • Fax:
Mailing address:
  • Phone: 904-953-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A2900X
TaxonomyNeurocritical Care Physician
License Number009492
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code2084A2900X
TaxonomyNeurocritical Care Physician
License NumberOS21283
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: