Healthcare Provider Details

I. General information

NPI: 1235286527
Provider Name (Legal Business Name): HYDE PARK MEDICAL ARTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 12/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6671 HYDE GROVE AVE
JACKSONVILLE FL
32210-2839
US

IV. Provider business mailing address

6671 HYDE GROVE AVE
JACKSONVILLE FL
32210-2839
US

V. Phone/Fax

Practice location:
  • Phone: 904-783-3700
  • Fax: 904-695-2579
Mailing address:
  • Phone: 904-783-3700
  • Fax: 904-695-2579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberOS7282
License Number StateFL

VIII. Authorized Official

Name: MS. REBECCA JANE HAYNES
Title or Position: OFFICE MANAGER
Credential:
Phone: 904-783-3700