| Organization Name: | SOUTHEAST RADIOLOGY ASSOCIATES PL |
| NPI Number: | 1467409631 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JOHN R DETELICH (CEO) |
| Mailing Address: | 340 Nw Commerce Dr Lake City |
| State: | FL US |
| Postal Code: | 320554709 |
| Phone Number: | 3867199000 |
| Fax Number: | |
| NPI Enumeration Date: | 05/31/2006 |
| NPI Last Update Date: | 10/17/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2085B0100X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Radiology |
| Taxonomy Specialization: | Body Imaging |
| Taxonomy Definition: | A Radiology doctor of Osteopathy that specializes in Body Imaging. |