Healthcare Provider Details

I. General information

NPI: 1609005693
Provider Name (Legal Business Name): VIKAS VINODRAY BHIMANI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2009
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14810 OLD SAINT AUGUSTINE RD STE 208
JACKSONVILLE FL
32258-2558
US

IV. Provider business mailing address

14810 OLD SAINT AUGUSTINE RD STE 208
JACKSONVILLE FL
32258-2558
US

V. Phone/Fax

Practice location:
  • Phone: 904-260-4111
  • Fax:
Mailing address:
  • Phone: 904-260-4111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME171670
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: