Basic Information
| Provider Information | |||||||||
| NPI: | 1912231689 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JUPITER VASCULAR CENTER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1058 KEENE RD | ||||||||
| Address2: | |||||||||
| City: | DUNEDIN | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346986300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7274740090 | ||||||||
| FaxNumber: | 7274740098 | ||||||||
| Practice Location | |||||||||
| Address1: | 1680 S CENTRAL BLVD | ||||||||
| Address2: | #112 | ||||||||
| City: | JUPITER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334587395 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5617481116 | ||||||||
| FaxNumber: | 5617482997 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2009 | ||||||||
| LastUpdateDate: | 09/28/2009 | ||||||||
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| AuthorizedOfficialLastName: | NUNLEY | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | M.D. | ||||||||
| AuthorizedOfficialTelephone: | 5617481116 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.