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Individual

DONALD W TICE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.O.

Contact information

Practice address
141 HILDEN RD STE 201, PONTE VEDRA, FL 32081-8400
(904) 825-1941
(904) 390-7460
Mailing address
PO BOX 746638, ATLANTA, GA 30374-6638
(904) 202-1032
(904) 376-4107

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
D01509
NV
207Q00000X
Family Medicine Physician
Primary
OS19428
FL

Other

Enumeration date
03/23/2006
Last updated
03/05/2024
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