NPIMap

Organization Active NPI

Jacksonville Otolaryngology & Facial Plastic Surgery

  • Facial Plastic Surgery Physician
  • Jacksonville, FL
National Provider Identifier
1306035951
Registry record updated Oct 19, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Facial Plastic Surgery PhysicianTaxonomy code 207YS0123X
License
ME #90519 Issued in FL
Legal business name
JACKSONVILLE OTOLARYNGOLOGY & FACIAL PLASTIC SURGERY
Practice address
836 Prudential Dr Ste 807
Jacksonville, FL 32207-8335
Phone
(904) 396-8060
Fax
(904) 396-9700
NPI assigned
Oct 19, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Juliann P Cannon
Title
Office Manager
Phone
(904) 396-8060

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Facial Plastic Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207YS0123X ME #90519 FL Primary

Addresses

Primary practice location

836 Prudential Dr Ste 807
Jacksonville, FL 32207-8335

Mailing address

836 Prudential Dr Ste 807
Jacksonville, FL 32207-8335
Phone (904) 396-8060

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1192752000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1192752000000",
    "number": "1306035951",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "836 PRUDENTIAL DR STE 807",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322078335",
            "telephone_number": "904-396-8060",
            "fax_number": "904-396-9700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "836 PRUDENTIAL DR STE 807",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322078335",
            "telephone_number": "904-396-8060",
            "fax_number": "904-396-9700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSONVILLE OTOLARYNGOLOGY & FACIAL PLASTIC SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-19",
        "last_updated": "2007-10-19",
        "status": "A",
        "authorized_official_last_name": "CANNON",
        "authorized_official_first_name": "JULIANN",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "904-396-8060"
    },
    "taxonomies": [
        {
            "code": "207YS0123X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Otolaryngology, Facial Plastic Surgery",
            "state": "FL",
            "license": "ME #90519",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.