Individual
MR. JASON MANUEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
13400 SUTTON PARK DR S, SUITE 1103, JACKSONVILLE, FL 32224-0236
(904) 223-8818
(904) 223-6969
Mailing address
13400 SUTTON PARK DR S, SUITE 1103, JACKSONVILLE, FL 32224-0236
(904) 223-8818
(904) 223-6969
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
PO2551
FL
213ES0103X
Foot & Ankle Surgery Podiatrist
P02551
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
390397400
—
FL
01
—
480031776
RR MEDICARE
FL
01
—
65442
BLUE CROSS
FL
Enumeration date
11/18/2005
Last updated
04/23/2013
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