Healthcare Provider Details

I. General information

NPI: 1790704153
Provider Name (Legal Business Name): MARC EDWARD TAFFLIN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 BARRS ST SUITE 601
JACKSONVILLE FL
32204-4742
US

IV. Provider business mailing address

104 LINKSIDE CIR
PONTE VEDRA BEACH FL
32082-2031
US

V. Phone/Fax

Practice location:
  • Phone: 904-384-8444
  • Fax: 904-308-6089
Mailing address:
  • Phone: 904-273-4450
  • Fax: 904-273-2188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberOS3659
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: