MEDICARE: FIRST CHOICE ENDOCRINOLOGY 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972067528
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRST CHOICE ENDOCRINOLOGY LLC

Provider Business Mailing Address
First Line	:	8837 GOODBYS EXECUTIVE DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-4605
Country	:	US
Telephone Number	:	904-990-0555
Fax Number	:	904-990-0551

Provider Business Practice Location Address
First Line	:	8837 GOODBYS EXECUTIVE DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-4605
Country	:	US
Telephone Number	:	904-990-0555
Fax Number	:	904-990-0551

Authorized Official
Title or Position	:	OWNER
Name	:	WASIM DEEB
Credential	:	MD
Telephone Number	:	904-990-0555

Provider Enumeration Date	:	01/29/2019
Last Update Date	:	09/13/2019

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