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Individual

DR. JOSE ALBERTO ETTEDGUI

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
841 PRUDENTIAL DR STE 280, JACKSONVILLE, FL 32207-8350
(904) 202-8550
(904) 393-7808
Mailing address
PO BOX 40767, JACKSONVILLE, FL 32203-0767
(904) 376-3707

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
ME86378
FL
2080P0202X
Pediatric Cardiology Physician
Primary
ME86378
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
000723269A
GA
05
2637286-00
FL
Enumeration date
03/12/2006
Last updated
05/11/2023
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