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NPI Code Detail

MEDICARE: MR. JON DABU VERCELES PA-C

MEDICARE: MR. JON DABU VERCELES PA-C
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
1363A00000XPhysician Assistant0010-03175NC
2363AM0700XMedical Physician Assistant0010-03175NC
3363AM0700XMedical Physician AssistantPA824NV
4363AS0400XSurgical Physician Assistant0010-03175NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2VWCHKLOTHERNVNORIDIAN
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1841263324
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JON DABU VERCELES PA-C
Provider Business Mailing Address
First Line : 3009 NEW BERN AVE
Second Line :
City : RALEIGH
State : NC
Zip : 27610-1214
Country : US
Telephone Number : 919-232-5020
Fax Number :
Provider Business Practice Location Address
First Line : 3009 NEW BERN AVE
Second Line :
City : RALEIGH
State : NC
Zip : 27610-1214
Country : US
Telephone Number : 919-232-5020
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/07/2006
Last Update Date : 09/01/2020

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