Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | ACN611 | FL |
NPI | 1023384179 |
---|---|
Provider Name | Dr. Rajesh Arun Persaud |
First Address | Saint Augustine, FL 32084-4167 |
Second Address | Saint Augustine, FL 32084-4167 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2012 |
Last Update Date | 08/02/2017 |