Healthcare Provider Details

I. General information

NPI: 1952374845
Provider Name (Legal Business Name): POORNIMA MUKERJI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 12/15/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 W 8TH ST
JACKSONVILLE FL
32209-6511
US

IV. Provider business mailing address

655 W 8TH ST
JACKSONVILLE FL
32209-6511
US

V. Phone/Fax

Practice location:
  • Phone: 904-244-8838
  • Fax: 904-244-2265
Mailing address:
  • Phone: 904-244-8838
  • Fax: 904-244-2265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME80918
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: