Individual
CORY GRANT PETERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
10475 CENTURION PKWY N, SUITE 220, JACKSONVILLE, FL 32256
(904) 634-0640
(904) 634-0203
Mailing address
6800 SOUTHPOINT PKWY STE 300, JACKSONVILLE, FL 32216-8203
(904) 634-0640
(904) 634-0203
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA9106781
FL
363AS0400X
Surgical Physician Assistant
Primary
PA9106781
FL
Other
Enumeration date
11/21/2006
Last updated
09/26/2024
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