Healthcare Provider Details

I. General information

NPI: 1578179586
Provider Name (Legal Business Name): FAIR AND BALANCED, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2020
Last Update Date: 09/16/2020
Certification Date: 09/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4131 UNIVERSITY BLVD S STE 3
JACKSONVILLE FL
32216-4346
US

IV. Provider business mailing address

4131 UNIVERSITY BLVD S STE 3
JACKSONVILLE FL
32216-4346
US

V. Phone/Fax

Practice location:
  • Phone: 904-312-9201
  • Fax: 904-312-9202
Mailing address:
  • Phone: 904-312-9201
  • Fax: 904-312-9202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: OM KAPOOR
Title or Position: DIRECTOR
Credential:
Phone: 904-312-9201