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General NPI Number Information
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NPI Number | 1457634263
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Entity Type | Organization
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Legal Business Name | MIGUEL DEJUK, PC
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Dates
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Enumeration Date | 09/28/2011
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Last Update Date | 03/02/2012
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Provider Practice Location Address
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Address Line | 800 ZEAGLER DR STE 210
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City | PALATKA
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State | FL
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Zip | 32177-3827
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Country | US
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Telephone | 386-328-8668
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Fax | 386-328-3767
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Provider Business Mailing Address
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Address Line | 800 ZEAGLER DR STE 210
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City | PALATKA
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State | FL
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Zip | 32177-3827
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Country | US
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Telephone | 386-328-8668
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Fax | 386-328-3767
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Authorized Official
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Title or Position | OWNER
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Name | MIGUEL GAZEL DEJUK
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Credential | MD
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Telephone | 386-328-8668
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | ME 0055591
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License Number State | FL
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