PETER C. JANSEN MD
Marriage and Family Therapists at 3 St, Macclenny, FL

License number
Florida ME0069804
Category
Osteopathic Medicine
Type
Family Medicine
Owner
Name: DR. PETER C JANSEN M.D.
Title: PHYSICIAN
Phone: (904) 259-7815
Address
Address 2
159 N 3Rd St, Macclenny, FL 32063
PO Box 8879, Orange Park, FL 32006
National Provider ID: 1346494556
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

See more information about PETER C. JANSEN MD at bizstanding.com

PETER C. JANSEN M.D. PA

Orange Park, FL  -  Macclenny, FL

Status:
Inactive
Inactive reason:
NAME CHANGE AMENDMENT
Registration:
Apr 18, 2001
Inactive since:
Apr 20, 2001
Addresses:
1075 Oakleaf Plantation Pkwy SUITE 108, Orange Park, FL 32065 (Physical)
Fleming Island, FL 32006 (Mailing)
159 N 3 St, Macclenny, FL 32063
PO Box 8879, Orange Park, FL 32006
State ID:
P01000039084
Business type:
Florida Profit Corporation
President, Treasurer, Secretary:
Peter M.d. Jansen (President, Treasurer, Secretary), 2222 Salt Myrtle Ln, Orange Park, FL 32003 (Physical)
Agent:
Watson, Todd,7785 Baymeadows Way SUITE 107, Jacksonville, FL 32256 (Physical)
EIN:
59-3712704

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