MEDICARE: SUGAR DOCTORS LLC

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	207RE0101X	Endocrinology, Diabetes & Metabolism Physician

General Provider Information

NPI Number	:	1922612886
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUGAR DOCTORS LLC

Provider Business Mailing Address
First Line	:	PO BOX 347
Second Line	:
City	:	ST AUGUSTINE
State	:	FL
Zip	:	32085-0347
Country	:	US
Telephone Number	:	904-280-6650
Fax Number	:

Provider Business Practice Location Address
First Line	:	8613 OLD KINGS RD S STE 301
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-4845
Country	:	US
Telephone Number	:	904-280-6650
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	JOHN A PURCELL
Credential	:	MD
Telephone Number	:	904-514-6331

Provider Enumeration Date	:	09/08/2020
Last Update Date	:	07/28/2022

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Directions to “SUGAR DOCTORS LLC ” Practice Location

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