Healthcare Provider Details

I. General information

NPI: 1629416805
Provider Name (Legal Business Name): BAPTIST CARDIOLOGY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2013
Last Update Date: 06/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1747 BAPTIST CLAY RD SUITE 320
FLEMING ISLAND FL
32003-8501
US

IV. Provider business mailing address

1905 CORPORATE SQUARE BLVD
JACKSONVILLE FL
32216-1940
US

V. Phone/Fax

Practice location:
  • Phone: 904-224-5185
  • Fax: 904-278-7284
Mailing address:
  • Phone: 904-720-0799
  • Fax: 904-720-5225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number605342
License Number StateFL

VIII. Authorized Official

Name: DR. MARK MASTERS
Title or Position: PRESIDENT
Credential: PHD
Phone: 904-720-0799