GERARD A COLUCCELLI MD PA (NPI# 1477605962) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1477605962 |
| Entity Type | Organization |
| Organization Name | GERARD A COLUCCELLI MD PA |
| Practice Address |
1235 San Marco Blvd 401 Jacksonville FL 32207 |
| Practice Telephone | 9043463506 |
| Practice Fax Number | 9043460712 |
| Mailing Telephone | 9043463506 |
| Mailing Fax Number | 9043460712 |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2008-03-27 |
| Authorized Official Name | DR. GERARD A COLUCCELLI (PRESIDENT) |
| Authorized Official Telephone | 9043463506 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207W00000X | Ophthalmology | ME39542 | FL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | BLUE CROSS BLUE SHIELD | 15671 | 01 |
| FL | MEDICARE | K2484 | 01 |
| Street Address |
1235 SAN MARCO BLVD 401 |
| City | JACKSONVILLE |
| State | FL |
| Zip Code | 32207 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699762906 | Robert Allen Joyce | Internal Medicine | 1235 San Marco Blvd, 3rd Floor, Jacksonville, FL 32207 | 2005-10-03 |
| 1962862466 | Stephanie Palazzolo | Physician Assistant | 1235 San Marco Blvd, Suite 2, Jacksonville, FL 32207-8554 | 2016-02-26 |
| 1609286897 | Baptist-southeast Gynecologic Oncology Inc | Radiology | 1235 San Marco Blvd, Suite 1, Jacksonville, FL 32207-8554 | 2014-04-28 |
| 1538593124 | Baptist - Southeast Gynecologic Oncology Associates, Inc. | Internal Medicine | 1235 San Marco Blvd, Suite 2, Jacksonville, FL 32207-8554 | 2013-08-30 |
| 1548512056 | Cancer Specialists LLC | Durable Medical Equipment & Medical Supplies | 1235 San Marco Blvd, Suite 202, Jacksonville, FL 32207-8554 | 2012-10-08 |
| 1871849034 | Melinda Wheeley Fawbush | Nurse Practitioner | 1235 San Marco Blvd, #419, Jacksonville, FL 32207-8554 | 2012-07-25 |
| 1215101902 | 21st Century Oncology of Jacksonville LLC | Surgery | 1235 San Marco Blvd, Suite 3, Jacksonville, FL 32207-8554 | 2008-04-15 |
| 1437331733 | Nicole Sunderland Anderson | Radiology | 1235 San Marco Blvd, Suite 100, Jacksonville, FL 32207-8554 | 2007-11-29 |
| 1497956072 | John Ho Vu | Internal Medicine | 1235 San Marco Blvd, Suite 2, Jacksonville, FL 32207-8554 | 2007-05-30 |
| 1427109248 | Seth A Strope | Urology | 1235 San Marco Blvd, Suite 2, Jacksonville, FL 32207-8554 | 2007-01-16 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033768981 | North Florida Pediatrics, Pa | Pediatrics | 4501 Atlantic Boulevard, Jacksonville, FL 32207 | 2019-09-04 |
| 1578117024 | Pragna Mukesh Dholakia | Nurse Practitioner | 2624 Atlantic Blvd., Jacksonville, FL 32207 | 2019-08-01 |
| 1821653601 | The Adoption Authority, Inc. | Case Management | 4940 Emerson Street, Suite 103, Jacksonville, FL 32207 | 2019-05-07 |
| 1255896080 | Elizabeth Lynn Houghton | Social Worker | Sulzbacher Village, 904-720-2079, Jacksonville, FL 32207 | 2019-02-06 |
| 1902374630 | Guilherme Jose Agnoletto | Neurological Surgery | 800 Prudential Drive Weaver Tower 11th Floor, Jacksonville, FL 32207 | 2018-11-12 |
| 1073008504 | Pavilion Infusion Therapy Inc | Durable Medical Equipment & Medical Supplies | 1301 Palm Avenue, Suite 220, Jacksonville, FL 32207 | 2018-06-27 |
| 1346733185 | Dueseason1 | Registered Nurse | 4058 Saint Augustine Rd, Jacksonville, FL 32207 | 2018-06-06 |
| 1164911913 | Eric Lang Poovey | Nurse Practitioner | Baptist Heart Specialists, 836 Prudential Drive Suite 1700, Jacksonville, FL 32207 | 2018-05-08 |
| 1902311046 | Spring Park Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 3851 Emerson St Ste 13, Jacksonville, FL 32207 | 2017-12-12 |
| 1295247948 | Emed Urgent and Primary Care Pa | Clinic/Center | 2570 Atlantic Boulevard, Jacksonville, FL 32207 | 2017-11-02 |
| Find all providers in zip 32207 | ||||
| Taxonomy Code | 207W00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Ophthalmology |
| An ophthalmologist has the knowledge and professional skills needed to provide comprehensive eye and vision care. Ophthalmologists are medically trained to diagnose, monitor and medically or surgically treat all ocular and visual disorders. This includes problems affecting the eye and its component structures, the eyelids, the orbit and the visual pathways. In so doing, an ophthalmologist prescribes vision services, including glasses and contact lenses. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Ophthalmology, 2007. http://www.abop.org/. American Osteopathic Board of Ophthalmology and Otolaryngology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Ophthalmology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Ophthalmology and Otolaryngology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790216729 | Kumar Sambhav | Ophthalmology | 580 W 8th Street, Tower - II, 3rd Floor, Department of Ophthalmology, Jacksonville, FL 32209 | 2017-03-22 |
| 1306227335 | Sepehr Bahadorani | Ophthalmology | 580 W 8th St Fl Towerii3, Uf College of Medicine - Jacksonville, Jacksonville, FL 32209-6533 | 2015-06-16 |
| 1467854240 | Mohammed Ali Tawfik Alyouzbaki | Ophthalmology | 6054 Wateredge Drive South, Jacksonville, FL 32211 | 2014-09-23 |
| 1841580214 | Chad Michael Kaplan | Ophthalmology | 653 West 8th St, Jacksonville, FL 32209 | 2011-04-19 |
| 1730479650 | Abdallah Mohamed Jeroudi | Ophthalmology | 2639 Oak St, Jacksonville, FL 32204 | 2011-04-12 |
| 1881915619 | Omar Gayasaddin | Ophthalmology | 7051 Southpoint Pkwy S Fl 3, Jacksonville, FL 32216-8713 | 2010-06-16 |
| 1952630121 | Ralph Alphonse Sawyer | Ophthalmology | 10061 Lakes End Ct, Jacksonville, FL 32256-4112 | 2009-12-16 |
| 1326193020 | Midwest Eye Associates, LLC | Ophthalmology | 1122 Veterans Dr, Suite B, Jacksonville, IL 62650-4032 | 2007-01-24 |
| 1023118379 | Jeffrey Herschel Levenson | Ophthalmology | 751 Oak St Ste 200, Jacksonville, FL 32204-3361 | 2006-09-25 |
| 1942317680 | Gerard A. Coluccelli | Ophthalmology | 931 Brookwood Rd, Jacksonville, FL 32207-4211 | 2006-08-25 |
| Find all providers in JACKSONVILLE | ||||
| City | JACKSONVILLE |
| Zip Code | 32207 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.