Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | ME53236 | FL |
NPI | 1124099338 |
---|---|
Provider Name | Jack J Messina |
First Address | Jacksonville, FL 32204-4735 |
Second Address | Jacksonville, FL 32204-4735 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2006 |
Last Update Date | 10/05/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
068952100 | (05) | FL |
A63971 | (02) |