Healthcare Provider Details

I. General information

NPI: 1740214386
Provider Name (Legal Business Name): NUMA FLETCHER TURNER III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 07/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1955 U.S. 1 SOUTH VETERAN'S ADMINISTRATION OUTPATIENT CLINIC
ST AUGUSTINE FL
32086
US

IV. Provider business mailing address

1955 US HIGHWAY 1 S VETERAN'S ADMINISTRATION OUTPATIENT CLINIC
ST AUGUSTINE FL
32086-3708
US

V. Phone/Fax

Practice location:
  • Phone: 904-494-0814
  • Fax:
Mailing address:
  • Phone: 904-494-0814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberME90322
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: