Healthcare Provider Details

I. General information

NPI: 1215078977
Provider Name (Legal Business Name): REGIONAL OBSTETRIC CONSULTANTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

836 PRUDENTIAL DR SUITE 1800
JACKSONVILLE FL
32207-8334
US

IV. Provider business mailing address

836 PRUDENTIAL DR SUITE 1800
JACKSONVILLE FL
32207-8334
US

V. Phone/Fax

Practice location:
  • Phone: 904-398-7684
  • Fax: 904-398-4998
Mailing address:
  • Phone: 904-398-7684
  • Fax: 904-398-4998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. DIANE KAYE THRASHER
Title or Position: OFFICE MANAGER
Credential:
Phone: 904-398-7684