Provider Demographics
NPI:1073806378
Name:RADABAUGH, JEFFREY PAUL (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:PAUL
Last Name:RADABAUGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 41516
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32203-1516
Mailing Address - Country:US
Mailing Address - Phone:904-202-5111
Mailing Address - Fax:904-391-5836
Practice Address - Street 1:836 PRUDENTIAL DR STE 1601
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8343
Practice Address - Country:US
Practice Address - Phone:904-396-8060
Practice Address - Fax:904-390-7385
Is Sole Proprietor?:No
Enumeration Date:2011-05-18
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS4846207Y00000X
KYR2620207Y00000X
FLME151381207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology