Organization
SOUTHEAST OUTPATIENT CONSULTANTS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEEVID MILLER (REGISTERED AGENT)
(904) 421-2119
Entity
Organization
Contact information
Practice address
1465 KINGSLEY AVE, 1201, ORANGE PARK, FL 32073-4504
(904) 421-2119
Mailing address
1665 KINGSLEY AVE, SUITE 105, ORANGE PARK, FL 32073-4490
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
Other
Enumeration date
07/19/2013
Last updated
07/19/2013
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