Healthcare Provider Details

I. General information

NPI: 1881013928
Provider Name (Legal Business Name): RYOSUKE MIYAUCHI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2014
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 W 8TH ST
JACKSONVILLE FL
32209-6511
US

IV. Provider business mailing address

PO BOX 44008
JACKSONVILLE FL
32231-4008
US

V. Phone/Fax

Practice location:
  • Phone: 904-244-4224
  • Fax: 904-244-3186
Mailing address:
  • Phone: 904-244-4224
  • Fax: 904-244-3186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberMFC1992
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: