Provider Demographics
NPI:1962127209
Name:BALL, JEFFERY DONNELL SCHMEAR SR
Entity type:Individual
Prefix:
First Name:JEFFERY
Middle Name:DONNELL SCHMEAR
Last Name:BALL
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:MARRIZA
Other - Middle Name:FENECIA
Other - Last Name:SALARI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3103 CAPTIVA BLUFF RD N
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32226-2067
Mailing Address - Country:US
Mailing Address - Phone:904-649-3908
Mailing Address - Fax:
Practice Address - Street 1:3103 CAPTIVA BLUFF RD N
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32226-2067
Practice Address - Country:US
Practice Address - Phone:904-649-3908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLB400-424-80-216-0343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)