Healthcare Provider Details

I. General information

NPI: 1962598623
Provider Name (Legal Business Name): BAHRI ORTHOPEDICS & SPORTS MEDICINE CLINIC, P.L.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 05/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 KENNERLY ROAD SUITE 101
JACKSONVILLE FL
32216
US

IV. Provider business mailing address

6100 KENNERLY ROAD SUITE 101
JACKSONVILLE FL
32216
US

V. Phone/Fax

Practice location:
  • Phone: 904-739-0050
  • Fax:
Mailing address:
  • Phone: 904-739-0050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. LORI BALL BAHRI
Title or Position: ADMINISTRATOR
Credential:
Phone: 904-739-0050