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General NPI Number Information
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NPI Number | 1912231689
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Entity Type | Organization
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Legal Business Name | JUPITER VASCULAR CENTER LLC
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Dates
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Enumeration Date | 09/28/2009
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Last Update Date | 09/28/2009
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Provider Practice Location Address
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Address Line | 1680 S CENTRAL BLVD #112
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City | JUPITER
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State | FL
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Zip | 33458-7395
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Country | US
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Telephone | 561-748-1116
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Fax | 561-748-2997
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Provider Business Mailing Address
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Address Line | 1058 KEENE RD
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City | DUNEDIN
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State | FL
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Zip | 34698-6300
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Country | US
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Telephone | 727-474-0090
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Fax | 727-474-0098
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Authorized Official
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Title or Position | M.D.
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Name | DAVID C NUNLEY
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Credential |
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Telephone | 561-748-1116
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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