Organization
JACKSONVILLE NEUROLOGICAL CLINIC, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DENNIS DEWEY MD (PRESIDENT)
(904) 276-2220
Entity
Organization
Contact information
Practice address
1895 KINGSLEY AVE STE 805, ORANGE PARK, FL 32073-4410
(904) 276-2220
(904) 276-2578
Mailing address
PO BOX 17809, JACKSONVILLE, FL 32245-7809
(904) 723-0015
(904) 338-0951
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00506
BCBS
FL
01
—
CF1455
RAILROAD MEDICARE
FL
Enumeration date
05/31/2006
Last updated
11/20/2007
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