Healthcare Provider Details

I. General information

NPI: 1346202488
Provider Name (Legal Business Name): WOMENS HEALTH CARE OF ST AUGUSTINE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 08/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 WHITEHALL DR STE 108
ST AUGUSTINE FL
32086-5268
US

IV. Provider business mailing address

101 WHITEHALL DR STE 108
ST AUGUSTINE FL
32086-5268
US

V. Phone/Fax

Practice location:
  • Phone: 904-797-4440
  • Fax: 904-797-4997
Mailing address:
  • Phone: 904-797-4440
  • Fax: 904-797-4997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberFLME0055260
License Number StateFL

VIII. Authorized Official

Name: DR. ROBERT E DUPREE JR
Title or Position: OWNER/PRESIDENT
Credential: MD
Phone: 904-797-4440