Pecoraro, Russell Anthony
Pecoraro, Russell Anthony is an sole proprietor health care provider with primary practice located at 2023 Professional Center Dr , Orange Park FL 32073-4468. He recently has only one registered license in Allopathic & Osteopathic Physicians / Ophthalmology, which is considered as his primary health care specialty. Pecoraro, Russell Anthony can be contacted via phone (904) 272-2020.Contact Information
Primary practice address
2023 Professional Center Dr
Orange Park FL 32073-4468
Phone: (904) 272-2020
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Ophthalmology | 207W00000X | ME97791 | Florida |
| Allopathic & Osteopathic Physicians / Ophthalmology | 207W00000X | R0838 | Kentucky |
Profile Details
| NPI number | 1891887394 |
|---|---|
| LBN Legal business name | Pecoraro, Russell Anthony |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Sep 29th, 2006 |
| Last updated | Apr 5th, 2017 - about 7 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1891887394 | NPPES |
| Kentucky | MEDICAID | 7100007660 |
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