MEDICARE: MR. DONALD EUGENE TURNER JR. LMT

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	174400000X	Specialist	MA41715	FL
2	225700000X	Massage Therapist	MA41715

General Provider Information

NPI Number	:	1710016506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DONALD EUGENE TURNER JR. LMT

Provider Business Mailing Address
First Line	:	5 PALM ROW
Second Line	:	SUITE C
City	:	ST. AUGUSTINE
State	:	FL
Zip	:	32084
Country	:	US
Telephone Number	:	904-687-8734
Fax Number	:

Provider Business Practice Location Address
First Line	:	4216 CORAL PARK DR
Second Line	:	SUTIE 103
City	:	BRUNSWICK
State	:	GA
Zip	:	31520-3016
Country	:	US
Telephone Number	:	912-297-8111
Fax Number	:

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

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	03/13/2012

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