Healthcare Provider Details

I. General information

NPI: 1326144700
Provider Name (Legal Business Name): JEFFREY D. CAUDILL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 12/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5851 TIMUQUANA RD SUITE 401
JACKSONVILLE FL
32210-7878
US

IV. Provider business mailing address

5851 TIMUQUANA RD SUITE 401
JACKSONVILLE FL
32210-7878
US

V. Phone/Fax

Practice location:
  • Phone: 904-317-5069
  • Fax:
Mailing address:
  • Phone: 904-317-5069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberME88799
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: