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General NPI Number Information
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NPI Number | 1760911051
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Entity Type | Organization
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Legal Business Name | JEC PHYSICIAN SERVICES, LLC
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Dates
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Enumeration Date | 06/08/2017
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Last Update Date | 10/29/2024
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Provider Practice Location Address
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Address Line | 5272 SUMMERLIN COMMONS WAY STE 603
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City | FORT MYERS
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State | FL
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Zip | 33907-2156
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Country | US
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Telephone | 239-444-8969
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Fax | 239-466-2035
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Provider Business Mailing Address
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Address Line | 5272 SUMMERLIN COMMONS WAY STE 603
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City | FORT MYERS
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State | FL
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Zip | 33907-2156
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Country | US
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Telephone | 239-444-8969
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Fax | 239-466-2035
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JULIO E CONRADO
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Credential | M.D.
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Telephone | 239-444-8969
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | ME70286
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207RS0012X
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Taxonomy Name | Sleep Medicine (Internal Medicine) Physician
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License Number | ME70286
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License Number State | FL
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