Healthcare Provider Details

I. General information

NPI: 1053330787
Provider Name (Legal Business Name): EUGENE H MCCOSKEY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 KINGSLEY AVE STE 404
ORANGE PARK FL
32073-9207
US

IV. Provider business mailing address

PO BOX 380009
JACKSONVILLE FL
32205-0509
US

V. Phone/Fax

Practice location:
  • Phone: 904-441-1111
  • Fax: 904-441-1111
Mailing address:
  • Phone: 904-388-3357
  • Fax: 904-384-5746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberOS8208
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberOS8208
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: