| Russell Denea, Md, Llc | |
|
4102 A1a S Saint Augustine FL 32080-6942 | |
| (904) 471-1300 | |
| (904) 471-1333 |
| Full Name | Russell Denea, Md, Llc |
|---|---|
| Speciality | Psychiatry & Neurology - Psychiatry |
| Location | 4102 A1a S, Saint Augustine, Florida |
| Authorized Official Name and Position | Russell Denea (OWNER) |
| Authorized Official Contact | 9044711300 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Russell Denea, Md, Llc 4102 A1a S Saint Augustine FL 32080-6942 Ph: (904) 471-1300 | Russell Denea, Md, Llc 4102 A1a S Saint Augustine FL 32080-6942 Ph: (904) 471-1300 |
| NPI Number | 1972016210 |
|---|---|
| Provider Enumeration Date | 11/08/2017 |
| Last Update Date | 12/27/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972016210 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 102L00000X | Psychoanalyst | (* (Not Available)) | Secondary |
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
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