MEDICARE: NORTH FLORIDA CENTER FOR PREVENTIVE MEDICINE PA

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1508851270
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH FLORIDA CENTER FOR PREVENTIVE MEDICINE PA

Provider Business Mailing Address
First Line	:	14546 OLD SAINT AUGUSTINE RD
Second Line	:	SUITE 211
City	:	JACKSONVILLE
State	:	FL
Zip	:	32258-5468
Country	:	US
Telephone Number	:	904-268-5590
Fax Number	:	904-268-8305

Provider Business Practice Location Address
First Line	:	14546 OLD SAINT AUGUSTINE RD
Second Line	:	SUITE 211
City	:	JACKSONVILLE
State	:	FL
Zip	:	32258-5468
Country	:	US
Telephone Number	:	904-268-5590
Fax Number	:	904-268-8305

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	DR. JOHN KALAM
Credential	:	MD
Telephone Number	:	904-268-5590

Provider Enumeration Date	:	09/19/2005
Last Update Date	:	01/17/2013

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