Individual
RYAN CANTVILLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
2606 PARK ST, JACKSONVILLE, FL 32204-4520
(904) 388-4646
(904) 388-9017
Mailing address
2606 PARK ST, JACKSONVILLE, FL 32204-4520
(904) 388-4646
(904) 388-9017
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
OS12463
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OS 12463
STATELICENSE
FL
Enumeration date
04/09/2011
Last updated
04/13/2017
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