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General NPI Number Information
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NPI Number | 1891786059
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Entity Type | Individual
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Provider Name | VICTOR A MAQUERA MD
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Gender | Male
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Dates
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Enumeration Date | 11/04/2005
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Last Update Date | 01/06/2011
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Provider Practice Location Address
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Address Line | 1895 KINGSLEY AVE STE 903
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City | ORANGE PARK
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State | FL
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Zip | 32073-4466
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Country | US
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Telephone | 904-276-1663
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Fax | 904-276-2469
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Provider Business Mailing Address
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Address Line | PO BOX 17809
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City | JACKSONVILLE
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State | FL
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Zip | 32245-7809
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Country | US
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Telephone | 904-723-5665
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Fax | 904-338-0951
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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 | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | ME59449
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License Number State | FL
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