Healthcare Provider Details

I. General information

NPI: 1326403585
Provider Name (Legal Business Name): GENTLE CARE PODIATRY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2015
Last Update Date: 12/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8450 GATE PKWY W UNIT 1504
JACKSONVILLE FL
32216-1049
US

IV. Provider business mailing address

8450 GATE PKWY W UNIT 1504
JACKSONVILLE FL
32216-1049
US

V. Phone/Fax

Practice location:
  • Phone: 904-738-7381
  • Fax: 904-738-7259
Mailing address:
  • Phone: 904-738-7381
  • Fax: 904-738-7259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberPO3446
License Number StateFL

VIII. Authorized Official

Name: DR. DOMINIQUE MARIE RAMEAU
Title or Position: C.E.O.
Credential: DPM
Phone: 904-738-7381