Healthcare Provider Details

I. General information

NPI: 1467722025
Provider Name (Legal Business Name): FIRST COAST ENDOCRINOLOGY, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2012
Last Update Date: 06/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 HEALTH PARK BLVD SUITE 3008
ST AUGUSTINE FL
32086-3707
US

IV. Provider business mailing address

300 HEALTH PARK BLVD SUITE 3008
ST AUGUSTINE FL
32086-3707
US

V. Phone/Fax

Practice location:
  • Phone: 904-810-2425
  • Fax: 904-810-5321
Mailing address:
  • Phone: 904-810-2425
  • Fax: 904-810-5321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberME0067670
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME0067870
License Number StateFL

VIII. Authorized Official

Name: MR. ROBERT ANDREW OESTERLE
Title or Position: OWNER
Credential: M.D.
Phone: 904-810-2425