Healthcare Provider Details

I. General information

NPI: 1174673859
Provider Name (Legal Business Name): DRS BAKER & GILMOUR MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 12/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 HEALTH PARK BLVD SUITE 1006
ST AUGUSTINE FL
32086-3707
US

IV. Provider business mailing address

3550 UNIVERSITY BLVD S SUITE 302
JACKSONVILLE FL
32216-4246
US

V. Phone/Fax

Practice location:
  • Phone: 904-794-7050
  • Fax:
Mailing address:
  • Phone: 904-733-4444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JODY BOSTIC
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 904-733-4444