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NPI Code Detail

MEDICARE: DR. JOHN EZRA TRAINER III M.D.

MEDICARE: DR. JOHN EZRA TRAINER III M.D.
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
1207QA0000XAdolescent Medicine (Family Medicine) PhysicianME80458FL
2207Q00000XFamily Medicine PhysicianME80458FL

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 : 1699770990
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOHN EZRA TRAINER III M.D.
Provider Business Mailing Address
First Line : 6841 BLANDING BLVD
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32244-4418
Country : US
Telephone Number : 904-862-2175
Fax Number : 904-862-2175
Provider Business Practice Location Address
First Line : 6841 BLANDING BLVD
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32244-4418
Country : US
Telephone Number : 904-862-2175
Fax Number : 904-862-2175
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/15/2005
Last Update Date : 12/02/2022

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