Provider Demographics
NPI:1740394352
Name:CEBALLOS, JECEBU JOSOL (MD)
Entity Type:Individual
Prefix:DR
First Name:JECEBU
Middle Name:JOSOL
Last Name:CEBALLOS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:61 MEMORIAL MEDICAL PKWY
Mailing Address - Street 2:SUITE 2806
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-5981
Mailing Address - Country:US
Mailing Address - Phone:386-586-1920
Mailing Address - Fax:386-586-1921
Practice Address - Street 1:61 MEMORIAL MEDICAL PKWY
Practice Address - Street 2:SUITE 2806
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-5981
Practice Address - Country:US
Practice Address - Phone:386-586-1920
Practice Address - Fax:386-586-1921
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2023-11-29
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Provider Licenses
StateLicense IDTaxonomies
FLME96424207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine