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General NPI Number Information
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NPI Number | 1417905993
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Entity Type | Organization
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Legal Business Name | SOUTHEAST GYNECOLOGIC ONCOLOGY ASSOCIATES PA
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Dates
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Enumeration Date | 05/05/2006
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Last Update Date | 07/01/2008
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Provider Practice Location Address
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Address Line | 915 W MONROE ST #300
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City | JACKSONVILLE
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State | FL
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Zip | 32204-1149
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Country | US
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Telephone | 904-389-3993
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Fax | 904-389-3994
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Provider Business Mailing Address
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Address Line | 915 W MONROE ST #300
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City | JACKSONVILLE
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State | FL
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Zip | 32204-1149
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Country | US
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Telephone | 904-389-3993
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Fax | 904-389-3994
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. BRENDA DAVIS
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Credential |
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Telephone | 904-389-3993
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VX0201X
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Taxonomy Name | Gynecologic Oncology Physician
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License Number |
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License Number State |
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