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General NPI Number Information
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NPI Number | 1154689289
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Entity Type | Organization
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Legal Business Name | NEUROLOGY ASSOCIATES OF STARKE INC
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Dates
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Enumeration Date | 04/26/2012
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Last Update Date | 04/26/2012
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Provider Practice Location Address
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Address Line | 107 EDWARDS RD SUITE F
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City | STARKE
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State | FL
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Zip | 32091-3959
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Country | US
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Telephone | 904-368-8111
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Fax | 904-368-8103
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Provider Business Mailing Address
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Address Line | 107 EDWARDS RD SUITE F
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City | STARKE
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State | FL
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Zip | 32091-3959
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Country | US
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Telephone | 904-368-8111
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Fax | 904-368-8103
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Authorized Official
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Title or Position | OWNER
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Name | JOHN DECERCE
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Credential | M.D.
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Telephone | 904-368-8111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | ME68599
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License Number State | FL
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