Active NPI
Mark Edward Dedrick, AAS, BS, MSOM, AP
- Acupuncturist
- Jacksonville, FL
National Provider Identifier
1629165154
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Acupuncturist
- License
- AP1427
- Practice address
- 8280 Princeton Square Blvd W Ste 1
Jacksonville, FL 32256-0362 - Phone
- (904) 742-2967
- NPI assigned
- Oct 6, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Acupuncturist | 171100000X | AP1427 | FL | Primary |
Addresses
Primary practice location
8280 Princeton Square Blvd W Ste 1
Jacksonville, FL 32256-0362
Mailing address
3517 Docksider Dr N
Jacksonville, FL 32257-6329
Phone (904) 742-2967
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Associate of Applied Science, Bachelor of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AP1427 | FL | MD | Acupuncturist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160092800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1629165154",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3517 DOCKSIDER DR N",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322576329",
"telephone_number": "904-742-2967"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8280 PRINCETON SQUARE BLVD W STE 1",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322560362",
"telephone_number": "904-742-2967"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEDRICK",
"first_name": "MARK",
"middle_name": "EDWARD",
"name_prefix": "Dr.",
"credential": "AAS, BS, MSOM, AP",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-06",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "171100000X",
"taxonomy_group": "",
"desc": "Acupuncturist",
"state": "FL",
"license": "AP1427",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, FL
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- Wasim E Deeb, M.D.
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- Malu Deegan, LM CPM
- Hugh Deen, MD
- Deena S. Richman PHD PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.