Healthcare Provider Details

I. General information

NPI: 1295786242
Provider Name (Legal Business Name): HOWARD B EPSTEIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 03/26/2021
Certification Date: 03/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 SOUTHPARK CIR E
ST AUGUSTINE FL
32086-5137
US

IV. Provider business mailing address

12109 COUNTY ROAD 103
OXFORD FL
34484-2951
US

V. Phone/Fax

Practice location:
  • Phone: 904-824-1450
  • Fax:
Mailing address:
  • Phone: 352-205-8981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberME44446
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: