Organization
JACKSONVILLE MS AND NEUROLOGY CENTER, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VICTOR A MAQUERA MD (PRESIDENT)
(904) 276-1663
Entity
Organization
Contact information
Practice address
1895 KINGSLEY AVE STE 903, ORANGE PARK, FL 32073-4410
(904) 276-1663
(904) 276-2469
Mailing address
PO BOX 17809, JACKSONVILLE, FL 32245-7809
(904) 723-5665
(904) 338-0951
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
ME59449
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
28344
BCBS
FL
Enumeration date
11/05/2009
Last updated
01/24/2012
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