MEDICARE: FAMILY FIRST PRIMARY CARE 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	261QP2300X	Primary Care Clinic/Center	ME 97725	FL

General Provider Information

NPI Number	:	1942481429
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY FIRST PRIMARY CARE PA

Provider Business Mailing Address
First Line	:	1075 OAKLEAF PLANTATION PKWY
Second Line	:	SUITE 108
City	:	ORANGE PARK
State	:	FL
Zip	:	32065-3624
Country	:	US
Telephone Number	:	904-282-4565
Fax Number	:	904-282-4225

Provider Business Practice Location Address
First Line	:	1075 OAKLEAF PLANTATION PKWY
Second Line	:	SUITE 108
City	:	ORANGE PARK
State	:	FL
Zip	:	32065-3624
Country	:	US
Telephone Number	:	904-282-4565
Fax Number	:	904-282-4225

Authorized Official
Title or Position	:	OWNER
Name	:	ALLISON DASTA BUTLER
Credential	:	MD
Telephone Number	:	904-282-4565

Provider Enumeration Date	:	11/26/2007
Last Update Date	:	05/12/2009

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