Healthcare Provider Details

I. General information

NPI: 1750443412
Provider Name (Legal Business Name): MAY ELLZA MONTRICHARD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 10/22/2020
Certification Date: 10/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6841 BLANDING BLVD
JACKSONVILLE FL
32244
US

IV. Provider business mailing address

6841 BLANDING BLVD
JACKSONVILLE FL
32244-4418
US

V. Phone/Fax

Practice location:
  • Phone: 904-862-2175
  • Fax: 305-698-6536
Mailing address:
  • Phone: 904-862-2175
  • Fax: 305-698-6536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME72631
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: