Michael R Medved, PA
Physician Assistant, Medical in Saint Augustine, FL. Individual provider (NPI-1).
NPI number1679690366
StatusActive
Last updated in NPPESDec 13, 2023
Details
- NPI
- 1679690366
- Entity type
- Individual (NPI-1)
- Name
- Mr. Michael R Medved
- Credential
- PA
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Mar 26, 2007
- Certification date
- Dec 13, 2023
- Last updated
- Dec 13, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363AM0700X | Physician Assistant, Medical | PA3163 | FL | Yes |
Practice location
3560 A1a SSaint Augustine, FL 32080-9731
Phone 904-584-2273 · Fax 904-823-9394
Mailing address
3560 A1a SSaint Augustine, FL 32080-9731
Phone 904-584-2273 · Fax 904-429-9783
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