Healthcare Provider Details

I. General information

NPI: 1881898377
Provider Name (Legal Business Name): JAMII ST JULIEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 11/06/2023
Certification Date: 11/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9332 STATE ROAD 54 STE 303
TRINITY FL
34655-1810
US

IV. Provider business mailing address

9332 STATE ROAD 54 STE 303
TRINITY FL
34655-1810
US

V. Phone/Fax

Practice location:
  • Phone: 727-375-8313
  • Fax: 727-375-8321
Mailing address:
  • Phone: 727-375-8313
  • Fax: 727-376-8321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME126530
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: