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General NPI Number Information
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NPI Number | 1457587891
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Entity Type | Organization
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Legal Business Name | PERRY JC MD PA
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Dates
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Enumeration Date | 05/29/2009
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Last Update Date | 05/27/2011
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Provider Practice Location Address
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Address Line | 7999 PHILIPS HWY STE 302
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City | JACKSONVILLE
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State | FL
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Zip | 32256-4443
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Country | US
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Telephone | 904-733-0099
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Fax | 904-733-0070
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Provider Business Mailing Address
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Address Line | PO BOX 3123
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City | ST AUGUSTINE
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State | FL
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Zip | 32085-3123
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Country | US
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Telephone | 904-824-4990
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Fax | 904-824-2226
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Authorized Official
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Title or Position | OWNER
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Name | PERRY J COLE
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Credential | MD
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Telephone | 904-733-0099
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | ME83999
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License Number State | FL
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