Individual
DERRICK LAVAR RAYSOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
2104 MASSEY AVE, JACKSONVILLE, FL 32228
(904) 270-4233
Mailing address
10088 KIT FOX PKWY, JACKSONVILLE, FL 32222-4188
(904) 686-6040
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
07/02/2010
Last updated
04/05/2019
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