Individual
EMILIO P SUPSUPIN JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
655 W 8TH ST, JACKSONVILLE, FL 32209-6511
(904) 244-4202
Mailing address
PO BOX 44008, JACKSONVILLE, FL 32231-4008
(904) 244-4202
Taxonomy
Speciality
Code
Description
License number
State
2085N0700X
Neuroradiology Physician
Primary
ME152526
FL
2085R0202X
Diagnostic Radiology Physician
N5422
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
182077101
—
TX
01
—
182077102
CSHCN
TX
01
—
8S7138
BCBSTX
TX
Enumeration date
07/05/2006
Last updated
03/09/2025
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