Individual
DR. CASEY M MCCLONE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
216 SOUTHPARK CIR E STE 216, ST AUGUSTINE, FL 32086-5135
(904) 634-0640
(904) 634-0203
Mailing address
6800 SOUTHPOINT PKWY STE 300, JACKSONVILLE, FL 32216-8203
(904) 634-0640
(904) 634-0203
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
51995
MN
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
ME108685
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002434000
—
FL
05
—
ENROLLED
—
MN
01
—
P00771178
MEDICARE RAILROAD
MN
Enumeration date
06/25/2007
Last updated
10/09/2023
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