Provider Demographics
NPI:1851856652
Name:JC PHYSICIAN ASSOCIATES PLLC
Entity type:Organization
Organization Name:JC PHYSICIAN ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:RUEDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-972-5299
Mailing Address - Street 1:3319 S STATE ROAD 7 STE 105
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33449-8099
Mailing Address - Country:US
Mailing Address - Phone:561-557-3115
Mailing Address - Fax:561-425-5147
Practice Address - Street 1:3319 S STATE ROAD 7 STE 105
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33449-8099
Practice Address - Country:US
Practice Address - Phone:561-557-3115
Practice Address - Fax:561-425-5147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-05
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the HandGroup - Single Specialty
No208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
No2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the HandGroup - Single Specialty