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General NPI Number Information
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NPI Number | 1508986936
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Entity Type | Organization
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Legal Business Name | MARK A MESSINESE MD PA
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Dates
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Enumeration Date | 03/30/2007
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Last Update Date | 02/12/2010
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Provider Practice Location Address
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Address Line | 1127 16TH AVE S
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City | JACKSONVILLE BEACH
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State | FL
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Zip | 32250-3213
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Country | US
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Telephone | 904-247-7778
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Fax | 904-241-9673
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Provider Business Mailing Address
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Address Line | 1127 16TH AVE S
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City | JACKSONVILLE BEACH
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State | FL
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Zip | 32250-3213
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Country | US
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Telephone | 904-247-7778
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Fax | 904-241-9673
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARK A. MESSINESE
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Credential | MD
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Telephone | 904-247-7778
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME64038
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License Number State | FL
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