Individual provider · NPI-1

Dr. Jecebu Josol Ceballos, M.D.

Family Medicine · Palm Coast, FL

NPI number1740394352
StatusActive
Last updated in NPPESNov 29, 2023

Details

NPI
1740394352
Entity type
Individual (NPI-1)
Name
Dr. Jecebu Josol Ceballos
Credential
M.D.
Sex
Male
Sole proprietor
No
Enumeration date
Aug 19, 2006
Certification date
Nov 29, 2023
Last updated
Nov 29, 2023

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207Q00000X Family Medicineme96424FLYes

Practice location

61 Memorial Medical Pkwy
Suite 2806
Palm Coast, FL 32164-5981

Phone 386-586-1920 · Fax 386-586-1921

Mailing address

61 Memorial Medical Pkwy
Suite 2806
Palm Coast, FL 32164-5981

Phone 386-586-1920 · Fax 386-586-1921

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