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General NPI Number Information
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NPI Number | 1114074200
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Entity Type | Organization
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Legal Business Name | ST VINCENTS PATHOLOGY ASSOCIATES PA
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Dates
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Enumeration Date | 01/04/2007
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Last Update Date | 06/12/2024
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Provider Practice Location Address
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Address Line | 1 SHIRCLIFF WAY DEPT OF PATHOLOGY
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City | JACKSONVILLE
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State | FL
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Zip | 32204-4748
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Country | US
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Telephone | 904-308-7300
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Fax | 904-308-2970
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Provider Business Mailing Address
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Address Line | PO BOX 144333
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City | ORLANDO
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State | FL
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Zip | 32814-4333
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Country | US
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Telephone | 407-422-9831
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Fax | 855-671-4753
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DON BERNARD DESTEPHANO
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Credential | MD
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Telephone | 904-308-7300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number |
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License Number State |
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