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General NPI Number Information
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NPI Number | 1336114842
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Entity Type | Individual
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Provider Name | SUNEEL KHETARPAL M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/19/2006
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Last Update Date | 09/03/2007
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Provider Practice Location Address
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Address Line | 655 W 8TH ST UFJP SURGERY TRAUMA
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City | JACKSONVILLE
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State | FL
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Zip | 32209-6511
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Country | US
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Telephone | 904-244-6631
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Fax | 904-244-4687
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Provider Business Mailing Address
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Address Line | PO BOX 44008 UFJP PROVIDER ENROLLMENT
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City | JACKSONVILLE
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State | FL
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Zip | 32231-4008
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Country | US
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Telephone | 904-244-3660
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Fax | 904-244-3425
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | ME94132
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2086S0102X
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Taxonomy Name | Surgical Critical Care Physician
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License Number | ME94132
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License Number State | FL
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