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General NPI Number Information
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NPI Number | 1114458916
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Entity Type | Organization
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Legal Business Name | JACKSONVILLE PEDIATRIC ENDOCRINOLOGY CLINIC PLLC
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Dates
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Enumeration Date | 03/23/2017
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Last Update Date | 03/27/2017
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Provider Practice Location Address
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Address Line | 9191 R G SKINNER PKWY
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City | JACKSONVILLE
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State | FL
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Zip | 32256-9655
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Country | US
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Telephone | 904-388-3351
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Fax |
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Provider Business Mailing Address
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Address Line | 13842 HARBOR CREEK PL
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City | JACKSONVILLE
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State | FL
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Zip | 32224-6895
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Country | US
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Telephone | 904-388-3351
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. REHAM HASAN
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Credential | M.D.
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Telephone | 904-388-3351
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0205X
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Taxonomy Name | Pediatric Endocrinology Physician
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License Number |
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License Number State |
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