Healthcare Provider Details

I. General information

NPI: 1124298831
Provider Name (Legal Business Name): MARGRET THORHALLSDOTTIR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2008
Last Update Date: 09/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6573 A1A S
SAINT AUGUSTINE FL
32080-7504
US

IV. Provider business mailing address

6573 A1A S
SAINT AUGUSTINE FL
32080-7504
US

V. Phone/Fax

Practice location:
  • Phone: 904-342-7363
  • Fax:
Mailing address:
  • Phone: 904-342-7363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME109067
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: