MEDICARE: NORTH FLORIDA RADIOLOGY ASSOCIATES PLLC

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
1	2085R0202X	Diagnostic Radiology Physician

General Provider Information

NPI Number	:	1356983829
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH FLORIDA RADIOLOGY ASSOCIATES PLLC

Provider Business Mailing Address
First Line	:	1992 LEWIS TURNER BLVD
Second Line	:
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32547-1255
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1992 LEWIS TURNER BLVD
Second Line	:
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32547-1255
Country	:	US
Telephone Number	:	850-315-7823
Fax Number	:

Authorized Official
Title or Position	:	MBR
Name	:	GERSTEL JEFFREY
Credential	:
Telephone Number	:	850-315-7823

Provider Enumeration Date	:	10/16/2019
Last Update Date	:	10/16/2019

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