Provider Demographics
NPI:1629043856
Name:VERNACCHIO, MICHAEL J (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:VERNACCHIO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1302 RIVER ST
Mailing Address - Street 2:
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32177-5042
Mailing Address - Country:US
Mailing Address - Phone:386-328-8371
Mailing Address - Fax:386-328-1519
Practice Address - Street 1:100 COMMERCIAL DR
Practice Address - Street 2:
Practice Address - City:KEYSTONE HEIGHTS
Practice Address - State:FL
Practice Address - Zip Code:32656-6802
Practice Address - Country:US
Practice Address - Phone:352-473-6595
Practice Address - Fax:352-473-6597
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS0004711207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL068874600Medicaid
FL068874600Medicaid
FL82644YMedicare PIN
FL82644ZMedicare PIN