MEDICARE: DR. MICHAEL LOUIS MIDDLEBROOKS D.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
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	DN 7934	FL

General Provider Information

NPI Number	:	1700879442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL LOUIS MIDDLEBROOKS D.M.D.

Provider Business Mailing Address
First Line	:	4232 BAYMEADOWS RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-4604
Country	:	US
Telephone Number	:	904-739-0690
Fax Number	:	904-737-1045

Provider Business Practice Location Address
First Line	:	4232 BAYMEADOWS RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-4604
Country	:	US
Telephone Number	:	904-739-0690
Fax Number	:	904-737-1045

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2005
Last Update Date	:	09/22/2010

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