Organization
JACKSONVILLE OTOLARYNGOLOGY & FACIAL PLASTIC SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JULIANN P CANNON (OFFICE MANAGER)
(904) 396-8060
Entity
Organization
Contact information
Practice address
836 PRUDENTIAL DR STE 807, JACKSONVILLE, FL 32207-8335
(904) 396-8060
(904) 396-9700
Mailing address
836 PRUDENTIAL DR STE 807, JACKSONVILLE, FL 32207-8335
(904) 396-8060
(904) 396-9700
Taxonomy
Speciality
Code
Description
License number
State
207YS0123X
Facial Plastic Surgery Physician
Primary
ME #90519
FL
Other
Enumeration date
10/19/2007
Last updated
10/19/2007
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