First Coast Orthopedic Associates LLC
Internal Medicine, Sports Medicine in Jacksonville, FL. Organization (NPI-2).
NPI number1053005348
StatusActive
Last updated in NPPESJun 8, 2023
Details
- NPI
- 1053005348
- Entity type
- Organization (NPI-2)
- Legal business name
- First Coast Orthopedic Associates LLC
- Organization subpart
- No
- Enumeration date
- Jun 8, 2023
- Certification date
- Jun 8, 2023
- Last updated
- Jun 8, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207RS0010X | Internal Medicine, Sports Medicine | – | – | Yes |
Practice location
6067 Kennerly RdJacksonville, FL 32216-4305
Phone 904-731-3131
Mailing address
3701 Windmoor DrJacksonville, FL 32217-4240
Phone 904-388-4712
Authorized official
Haissam Barakat
Credentialing
9049626005
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