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General NPI Number Information
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NPI Number | 1679897466
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Entity Type | Individual
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Provider Name | CERES LIM ROXAS M.D.
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Gender | Female
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Dates
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Enumeration Date | 03/23/2010
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Last Update Date | 03/23/2010
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Provider Practice Location Address
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Address Line | 100 N MAIN ST
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City | CHATTAHOOCHEE
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State | FL
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Zip | 32324-1107
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Country | US
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Telephone | 850-663-7501
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Fax | 850-663-7771
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Provider Business Mailing Address
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Address Line | 10360 HUNTINGTON FOREST BLVD E
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City | JACKSONVILLE
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State | FL
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Zip | 32257-7620
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Country | US
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Telephone | 904-699-0605
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | ME32140
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License Number State | FL
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