Don Bernard Destephano, MD

Primary specialty

Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X

License

ME53628 Issued in FL

Practice address

1 Shircliff Way
Dept of Pathology
Jacksonville, FL 32204-4748

Phone

(904) 308-3803

Fax

(904) 308-2970

NPI assigned

Jan 4, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1167868800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1539043200000",
    "number": "1518014695",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 144333",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328144333",
            "telephone_number": "407-422-9831",
            "fax_number": "407-206-1767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 SHIRCLIFF WAY",
            "address_2": "DEPT OF PATHOLOGY",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322044748",
            "telephone_number": "904-308-3803",
            "fax_number": "904-308-2970"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DESTEPHANO",
        "first_name": "DON",
        "middle_name": "BERNARD",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-04",
        "last_updated": "2018-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "FL",
            "license": "ME53628",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "064755100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kelly Elizabeth Desousa, MS, ATR
• Michelle Despres
• Riley Elizabeth Despres, RN
• Selmawit Desta
• Christopher Destephano, MD
• Erica Davalt Destephano, OT
• Patricia Ann Destephano, OTR
• Roseline A Desvaristes, M.D.
• Kevin John Determan, B.S.,D.C.,F.A.S.A.
• Jonathan L Detlefs, EXEMPT APP.

• Anatomic Pathology & Clinical Pathology Physician in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Anatomic Pathology & Clinical Pathology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.