Healthcare Provider Details

I. General information

NPI: 1821028739
Provider Name (Legal Business Name): TIMEA ALEXANDRA KECSKEMETI-KOVACS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 04/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450077 STATE ROAD 200 STE 12 UFJP CALLAHAN FAMILY PRACTICE
CALLAHAN FL
32011-3863
US

IV. Provider business mailing address

PO BOX 44008 UFJP PROVIDER ENROLLMENT
JACKSONVILLE FL
32231-4008
US

V. Phone/Fax

Practice location:
  • Phone: 904-633-0560
  • Fax: 904-633-0561
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME77823
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: