Healthcare Provider Details

I. General information

NPI: 1225423429
Provider Name (Legal Business Name): EDWARD DESCALLAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2015
Last Update Date: 01/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 KINGSLEY AVE
ORANGE PARK FL
32073-5148
US

IV. Provider business mailing address

110 IRVING ST NW DEPT OF EMERGENCY MEDICINE
WASHINGTON DC
20010-3017
US

V. Phone/Fax

Practice location:
  • Phone: 904-639-8500
  • Fax:
Mailing address:
  • Phone: 202-877-8080
  • Fax: 202-877-7633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME0135003
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: