# GERARD A COLUCCELLI MD PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1477605962
- **Authorized official:** DR. GERARD A COLUCCELLI M.D. (PRESIDENT)
- **Authorized official phone:** (904) 346-3506

## Contact information

- **Practice address:** 1235 SAN MARCO BLVD, 401, JACKSONVILLE, FL 32207
- **Practice address phone:** (904) 346-3506
- **Practice address fax:** (904) 346-0712
- **Mailing address:** 1235 SAN MARCO BLVD, 401, JACKSONVILLE, FL 32207
- **Mailing address phone:** (904) 346-3506
- **Mailing address fax:** (904) 346-0712

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | ME39542 | FL | Yes |

## Other

- **Enumeration date:** 01/17/2007
- **Last updated:** 03/27/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 15671 | BLUE CROSS BLUE SHIELD | FL |
| 01 | — | K2484 | MEDICARE | FL |