Organization
SOUTHEASTERN NEUROSCIENCE INSTITUTE PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACOB GREEN MD, PH.D (CEO, NEUROLOGIST)
(904) 346-0707
Entity
Organization
Contact information
Practice address
3728 PHILLIPS HWY, SUITE 31, JACKSONVILLE, FL 32207-9300
(904) 346-0707
(904) 396-4300
Mailing address
3728 PHILLIPS HWY, SUITE 32, JACKSONVILLE, FL 32207-9300
(904) 346-0707
(904) 396-4300
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
ME 59265
FL
174400000X
Specialist
Primary
ME0013636
FL
174400000X
Specialist
ME45606
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
059852600
—
FL
05
—
266403800
—
FL
05
—
380447000
—
FL
Enumeration date
05/07/2007
Last updated
05/20/2008
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