Healthcare Provider Details

I. General information

NPI: 1528256260
Provider Name (Legal Business Name): NAVARRE MEDICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 10/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8740 ORTEGA PARK DR
NAVARRE FL
32566-4139
US

IV. Provider business mailing address

8740 ORTEGA PARK DR
NAVARRE FL
32566-4139
US

V. Phone/Fax

Practice location:
  • Phone: 850-936-6211
  • Fax:
Mailing address:
  • Phone: 850-936-6211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME 93028
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME 93028
License Number StateFL

VIII. Authorized Official

Name: JEFFREY G. ELLINGTON
Title or Position: PRESIDENT
Credential: MD
Phone: 850-936-6211