Provider Demographics
NPI:1083733067
Name:EUSTACE, JOHN CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:CHARLES
Last Name:EUSTACE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:9000 SW 87TH CT
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2231
Mailing Address - Country:US
Mailing Address - Phone:305-273-7772
Mailing Address - Fax:305-273-7292
Practice Address - Street 1:9000 SW 87TH CT
Practice Address - Street 2:SUITE 103
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2231
Practice Address - Country:US
Practice Address - Phone:305-273-7772
Practice Address - Fax:305-273-7292
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME2690207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL92710Medicare ID - Type Unspecified