Healthcare Provider Details

I. General information

NPI: 1477607836
Provider Name (Legal Business Name): PEDIATRICS IN NORTH FLORIDA PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 12/10/2019
Certification Date: 12/10/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

385 PALM COAST PKWY SW UNIT 5
PALM COAST FL
32137-4784
US

IV. Provider business mailing address

PO BOX 3123
ST AUGUSTINE FL
32085-3123
US

V. Phone/Fax

Practice location:
  • Phone: 386-446-8333
  • Fax: 386-446-3345
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: RAPHAEL NG
Title or Position: OWNER
Credential: MD
Phone: 386-446-8333