Individual
GERARD A. COLUCCELLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
931 BROOKWOOD RD, JACKSONVILLE, FL 32207-4211
(904) 399-0441
Mailing address
931 BROOKWOOD RD, 900, JACKSONVILLE, FL 32207-4211
(904) 399-0441
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
ME39542
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15671
BCBS
FL
01
—
180000739
RAILROAD MEDICARE
FL
01
—
4045150
AETNA
FL
Enumeration date
08/25/2006
Last updated
11/20/2014
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