Organization
AMMALA CANTRELL
Active
Other names
CANTRELL MEDICAL CLINIC
Organization subpart
No
Provider details
NPI number
Authorized official
AMMALA CANTRELL MD (PRESIDENT)
(904) 673-5553
Entity
Organization
Contact information
Practice address
1370 13TH AVE S, SUITE 216A, JACKSONVILLE BEACH, FL 32250-3230
(904) 372-0208
(904) 853-6559
Mailing address
PO BOX 50670, JACKSONVILLE BEACH, FL 32240-0670
(904) 372-0208
(904) 853-6559
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
ME84833
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
K8204
BC/BS OF FLORIDA
FL
Enumeration date
11/07/2007
Last updated
10/12/2012
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