MEDICARE: DR. JOHN A PURCELL M.D.

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	174400000X	Specialist	ME56501	FL
2	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	ME56501	FL

General Provider Information

NPI Number	:	1235133505
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN A PURCELL M.D.

Provider Business Mailing Address
First Line	:	8613 OLD KINGS RD S STE 301
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-4845
Country	:	US
Telephone Number	:	904-280-6650
Fax Number	:

Provider Business Practice Location Address
First Line	:	8613 OLD KINGS RD S STE 301
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-4845
Country	:	US
Telephone Number	:	904-280-6650
Fax Number	:

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

Provider Enumeration Date	:	06/02/2005
Last Update Date	:	07/28/2022

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