Provider Demographics
NPI:1821077173
Name:JUNEAU, MICHAEL P (PA-C)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:P
Last Name:JUNEAU
Suffix:
Gender:M
Credentials:PA-C
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1824 KING ST
Mailing Address - Street 2:STE 200
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-4736
Mailing Address - Country:US
Mailing Address - Phone:904-384-3343
Mailing Address - Fax:904-400-6671
Practice Address - Street 1:836 PRUDENTIAL DR
Practice Address - Street 2:STE 1804
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8345
Practice Address - Country:US
Practice Address - Phone:904-398-3888
Practice Address - Fax:904-400-6675
Is Sole Proprietor?:No
Enumeration Date:2006-01-14
Last Update Date:2022-11-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9108713363AS0400X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003181725AMedicaid
FL015882500Medicaid
MEP00849252Medicare PIN
NH30336623Medicaid
MEAP108103Medicare PIN
MEAP108101Medicare PIN