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:
Map and Directions

Health care specialties

SpecialtyCodeLicense #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 9 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1891887394 NPPES
Kentucky MEDICAID 7100007660

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