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NPI Code Detail

MEDICARE: DJRJ2

MEDICARE: DJRJ2
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207V00000XObstetrics & Gynecology PhysicianME82558FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1164676771
Entity Type Code : Organization
Provider Name (Legal Business Name) : DJRJ2
Provider Business Mailing Address
First Line : PO BOX 805
Second Line :
City : LAKE CITY
State : FL
Zip : 32056-0805
Country : US
Telephone Number : 386-755-9190
Fax Number :
Provider Business Practice Location Address
First Line : 4225 NW AMERICAN LN
Second Line :
City : LAKE CITY
State : FL
Zip : 32055-8841
Country : US
Telephone Number : 386-365-3845
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DR. JOSEPH MICHAEL CHARL3S JR.
Credential : MD
Telephone Number : 386-365-3845
Provider Enumeration Date : 11/10/2008
Last Update Date : 11/10/2008

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Directions to “DJRJ2 ” Practice Location

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