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General NPI Number Information
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NPI Number | 1013375195
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Entity Type | Organization
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Legal Business Name | DUVAL VASCULAR CENTER, LLC
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Dates
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Enumeration Date | 02/04/2016
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Last Update Date | 09/24/2019
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Provider Practice Location Address
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Address Line | 915 W MONROE ST SUITE 100
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City | JACKSONVILLE
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State | FL
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Zip | 32204-1177
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Country | US
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Telephone | 904-518-1398
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Fax | 904-513-0231
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Provider Business Mailing Address
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Address Line | 3001 PALM HARBOR BLVD STE A
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City | PALM HARBOR
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State | FL
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Zip | 34683-1930
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Country | US
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Telephone | 727-474-0090
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Fax | 727-474-0055
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | JANET R. DEES
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Credential |
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Telephone | 727-474-0090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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