Basic Information
| Provider Information | |||||||||
| NPI: | 1710203435 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BALSEIRO | ||||||||
| FirstName: | JESSE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7224-1 MERRILL RD | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322773725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4077988800 | ||||||||
| FaxNumber: | 3213334292 | ||||||||
| Practice Location | |||||||||
| Address1: | 4348 SOUTHPOINT BLVD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322160986 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042811915 | ||||||||
| FaxNumber: | 9042811119 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2010 | ||||||||
| LastUpdateDate: | 06/01/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207U00000X | ME103629 | FL | N | Allopathic & Osteopathic Physicians | Nuclear Medicine | 207Q00000X | ME103629 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.