Individual
DR. JASON MARK RADECKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
14430 US HIGHWAY 1, SEBASTIAN, FL 32958-3237
(772) 581-8003
Mailing address
14430 US HIGHWAY 1, SEBASTIAN, FL 32958-3237
(772) 581-8003
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
ME-111397
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005473400
—
FL
Enumeration date
11/26/2007
Last updated
01/22/2014
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