Provider Demographics
NPI:1285262600
Name:CEBAK, JOHN ERIC (DO, PHD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ERIC
Last Name:CEBAK
Suffix:
Gender:M
Credentials:DO, PHD
Other - Prefix:DR
Other - First Name:JOHNNY
Other - Middle Name:
Other - Last Name:CEBAK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO, PHD
Mailing Address - Street 1:4500 SAN PABLO RD S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-1865
Mailing Address - Country:US
Mailing Address - Phone:904-953-2000
Mailing Address - Fax:
Practice Address - Street 1:4500 SAN PABLO RD S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-1865
Practice Address - Country:US
Practice Address - Phone:904-953-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-31
Last Update Date:2024-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0094922084A2900X
FLOS212832084A2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084A2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurocritical Care