Provider Demographics
NPI:1912231689
Name:JUPITER VASCULAR CENTER LLC
Entity Type:Organization
Organization Name:JUPITER VASCULAR CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:NUNLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-748-1116
Mailing Address - Street 1:1058 KEENE RD
Mailing Address - Street 2:
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-6300
Mailing Address - Country:US
Mailing Address - Phone:727-474-0090
Mailing Address - Fax:727-474-0098
Practice Address - Street 1:1680 S CENTRAL BLVD
Practice Address - Street 2:#112
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7395
Practice Address - Country:US
Practice Address - Phone:561-748-1116
Practice Address - Fax:561-748-2997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-28
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty