Healthcare Provider Details

I. General information

NPI: 1538646757
Provider Name (Legal Business Name): FLAGLER FAMILY MEDICINE P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2018
Last Update Date: 07/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 TUSCAN WAY STE 205
ST AUGUSTINE FL
32092-1850
US

IV. Provider business mailing address

130 HEALTH PARK BLVD
ST AUGUSTINE FL
32086-5776
US

V. Phone/Fax

Practice location:
  • Phone: 904-826-3469
  • Fax:
Mailing address:
  • Phone: 904-826-3469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: WARREN WHITLOCK
Title or Position: AUTHORIZED OFFICIAL / PARTNER
Credential: MD
Phone: 904-826-3469