Healthcare Provider Details

I. General information

NPI: 1497916803
Provider Name (Legal Business Name): FIRST COAST OBSTETRICS ASSOCIATES, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2008
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 KINGSLEY AVE
ORANGE PARK FL
32073-5148
US

IV. Provider business mailing address

2005 SALT MYRTLE LN
ORANGE PARK FL
32003-7073
US

V. Phone/Fax

Practice location:
  • Phone: 904-276-8500
  • Fax:
Mailing address:
  • Phone: 904-264-6620
  • Fax: 904-215-7960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT ROLAND POWERS JR.
Title or Position: PRESIDENT
Credential: M.D.
Phone: 904-264-9555