=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578635033
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STRATTON N STERGHOS JR. M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/13/2006
-----------------------------------------------------
Last Update Date | 04/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3117 SPRING GLEN RD STE 408
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32207-5977
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-858-1009
-----------------------------------------------------
Fax | 252-277-2643
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3117 SPRING GLEN RD STE 408
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32207-5977
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-858-1009
-----------------------------------------------------
Fax | 252-277-2643
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207VX0000X
-----------------------------------------------------
Taxonomy Name | Obstetrics Physician
-----------------------------------------------------
License Number | ME57480
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2083A0100X
-----------------------------------------------------
Taxonomy Name | Aerospace Medicine Physician
-----------------------------------------------------
License Number | ME57480
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------