| John Canterbury Pa | |
|
601 Ne 36th St Suite 3411 Miami FL 33137-3914 | |
| (305) 323-2095 | |
| Not Available |
| Full Name | John Canterbury Pa |
|---|---|
| Speciality | Internal Medicine |
| Location | 601 Ne 36th St, Miami, Florida |
| Authorized Official Name and Position | John Peter Canterbury (PRESIDENT) |
| Authorized Official Contact | 3053232095 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| John Canterbury Pa 601 Ne 36th St Suite 3411 Miami FL 33137-3914 Ph: (305) 323-2095 | John Canterbury Pa 601 Ne 36th St Suite 3411 Miami FL 33137-3914 Ph: (305) 323-2095 |
| NPI Number | 1174710123 |
|---|---|
| Provider Enumeration Date | 10/03/2007 |
| Last Update Date | 10/03/2007 |
| Medicare PECOS PAC ID | 5092803130 |
|---|---|
| Medicare Enrollment ID | O20071126000692 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174710123 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | John P Canterbury |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1316951148 PECOS PAC ID: 4880655737 Enrollment ID: I20041023000049 |
| Provider Name | Debra M Dooley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437389848 PECOS PAC ID: 0840482741 Enrollment ID: I20101011000806 |
| Provider Name | Lisa Mary Dominach |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811232515 PECOS PAC ID: 9830338359 Enrollment ID: I20140304001305 |
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