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General NPI Number Information
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NPI Number | 1417955196
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Entity Type | Organization
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Legal Business Name | JACKSONVILLE PEDIATRIC ASSOCIATES, M.D., P.A.
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Dates
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Enumeration Date | 07/07/2005
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Last Update Date | 01/13/2012
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Provider Practice Location Address
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Address Line | 8774 PERIMETER PARK BLVD
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City | JACKSONVILLE
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State | FL
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Zip | 32216-6347
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Country | US
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Telephone | 904-642-6100
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Fax | 904-642-5154
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Provider Business Mailing Address
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Address Line | 8774 PERIMETER PARK BLVD
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City | JACKSONVILLE
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State | FL
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Zip | 32216-6347
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Country | US
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Telephone | 904-642-6100
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Fax | 904-642-5154
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ENRIQUE MANUEL SILVA
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Credential | M.D.
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Telephone | 904-642-6100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | ME0044830
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License Number State | FL
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