Healthcare Provider Details

I. General information

NPI: 1750733580
Provider Name (Legal Business Name): EUGENE H MCCOSKEY, D.O., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2016
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: 904-384-5746
Mailing address:
  • Phone: 904-388-3357
  • Fax: 904-384-5746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberOS8208
License Number StateFL

VIII. Authorized Official

Name: DR. EUGENE H MCCOSKEY II
Title or Position: PRESIDENT/PHYSICIAN
Credential: D.O.
Phone: 904-923-0582