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General NPI Number Information
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NPI Number | 1790223972
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Entity Type | Organization
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Legal Business Name | JEFFREY DEMERCURIO MD PA
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Dates
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Enumeration Date | 02/07/2017
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Last Update Date | 09/25/2023
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Provider Practice Location Address
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Address Line | 1425 HAND AVE STE C
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City | ORMOND BEACH
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State | FL
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Zip | 32174-1136
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Country | US
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Telephone | 386-317-0444
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Fax | 386-275-1177
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Provider Business Mailing Address
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Address Line | 1425 HAND AVE STE C
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City | ORMOND BEACH
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State | FL
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Zip | 32174-1136
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Country | US
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Telephone | 386-317-0444
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Fax | 386-275-1177
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Authorized Official
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Title or Position | OWNER
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Name | JEFFREY DEMERCURIO
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Credential | MD
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Telephone | 386-882-0428
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | ME101551
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License Number State | FL
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