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Individual

JOAN WEBER IACOBELLI

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
2864 WELLNESS AVE STE 200, ORANGE CITY, FL 32763-8335
(386) 775-0333
(386) 775-0427
Mailing address
2864 WELLNESS AVE STE 200, ORANGE CITY, FL 32763-8335
(386) 775-0333
(386) 775-0427

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
16001
AL
208600000X
Surgery Physician
Primary
ME 108529
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
000083966
AL
05
003413400
FL
01
051083966
BLUE CROSS BLUE SHIELD
AL
01
14C4Y
BCBS
FL
Enumeration date
05/31/2006
Last updated
01/31/2020
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