Healthcare Provider Details
I. General information
NPI: 1831143940
Provider Name (Legal Business Name): JULIE A DECESARE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 05/22/2006
Last Update Date: 01/14/2022
Certification Date: 10/02/2020
Deactivation Date:
Reactivation Date:
III. Provider practice location address
8333 N DAVIS HWY FL 7
PENSACOLA FL
32514-6050
US
IV. Provider business mailing address
8333 N DAVIS HWY FL 7
PENSACOLA FL
32514-6050
US
V. Phone/Fax
- Phone: 850-969-2038
- Fax: 850-969-2037
- Phone: 850-969-2038
- Fax: 850-969-2037
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207V00000X |
| Taxonomy | Obstetrics & Gynecology Physician |
| License Number | ME80156 |
| License Number State | FL |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: