Organization
MCIVER UROLOGICAL CLINIC PATHOLOGY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN R WHITTAKER M.D. (PRESIDENT)
(904) 355-6583
Entity
Organization
Contact information
Practice address
1314 SUMTER ST, SUITE 110, LEESBURG, FL 34748-6385
(904) 355-6583
(904) 355-4922
Mailing address
710 LOMAX ST, JACKSONVILLE, FL 32204-4004
(904) 355-6583
(904) 355-4922
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Enumeration date
10/01/2007
Last updated
10/01/2007
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