Healthcare Provider Details

I. General information

NPI: 1316048143
Provider Name (Legal Business Name): ESTER S MACAM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 10/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 WEST 20TH STREET
JACKSONVILLE FL
32254
US

IV. Provider business mailing address

P.O. BOX 19249
JACKSONVILLE FL
32245-9249
US

V. Phone/Fax

Practice location:
  • Phone: 904-695-0249
  • Fax: 904-626-4994
Mailing address:
  • Phone: 904-743-1883
  • Fax: 904-743-5109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME43690
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: