Healthcare Provider Details

I. General information

NPI: 1336809557
Provider Name (Legal Business Name): LOWER KEYS RADIOLOGY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2021
Last Update Date: 07/12/2024
Certification Date: 07/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8375 DIX ELLIS TRL STE 201
JACKSONVILLE FL
32256-8241
US

IV. Provider business mailing address

2330 UTAH AVE STE 200
EL SEGUNDO CA
90245-4817
US

V. Phone/Fax

Practice location:
  • Phone: 904-399-5550
  • Fax: 904-346-4334
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: SHARLEE LEBLEU
Title or Position: VICE PRESIDENT
Credential:
Phone: 480-321-7026