MEDICARE: DOUGLAS SENECAL PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA9103241	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184691123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUGLAS SENECAL PA

Provider Business Mailing Address
First Line	:	PO BOX 740861
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-0861
Country	:	US
Telephone Number	:
Fax Number	:	904-819-4906

Provider Business Practice Location Address
First Line	:	110 HEALTH PARK BLVD
Second Line	:
City	:	SAINT AUGUSTINE
State	:	FL
Zip	:	32086-5776
Country	:	US
Telephone Number	:	904-823-3401
Fax Number	:	904-829-8649

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/08/2006
Last Update Date	:	09/10/2025

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Directions to “ DOUGLAS SENECAL PA” Practice Location

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