Healthcare Provider Details

I. General information

NPI: 1558694422
Provider Name (Legal Business Name): PHYSICIANS PRIMARY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2009
Last Update Date: 09/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 KINGSLEY AVE STE D
ORANGE PARK FL
32073-5139
US

IV. Provider business mailing address

9826 SAN JOSE BLVD
JACKSONVILLE FL
32257-5438
US

V. Phone/Fax

Practice location:
  • Phone: 904-213-1776
  • Fax:
Mailing address:
  • Phone: 904-262-9444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. GORDON B GARVER
Title or Position: MGRM/MEMBER
Credential: DC
Phone: 904-213-1776