Provider Demographics
NPI:1114458916
Name:JACKSONVILLE PEDIATRIC ENDOCRINOLOGY CLINIC PLLC
Entity Type:Organization
Organization Name:JACKSONVILLE PEDIATRIC ENDOCRINOLOGY CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:HASAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-388-3351
Mailing Address - Street 1:13842 HARBOR CREEK PL
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-6895
Mailing Address - Country:US
Mailing Address - Phone:904-388-3351
Mailing Address - Fax:
Practice Address - Street 1:9191 R G SKINNER PKWY
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-9655
Practice Address - Country:US
Practice Address - Phone:904-388-3351
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-23
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric EndocrinologyGroup - Single Specialty