Healthcare Provider Details

I. General information

NPI: 1851325781
Provider Name (Legal Business Name): N.F.L. CENTER FOR OTO-HNS FACIAL PLASTIC SURGERY P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 07/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 SAN BARTOLA DR
ST AUGUSTINE FL
32086-5767
US

IV. Provider business mailing address

3 SAN BARTOLA DR
ST AUGUSTINE FL
32086-5767
US

V. Phone/Fax

Practice location:
  • Phone: 904-823-8823
  • Fax: 904-808-1505
Mailing address:
  • Phone: 904-823-8823
  • Fax: 904-808-1505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ARTHUR CORT TALIAFERRO
Title or Position: OWNER
Credential: MD
Phone: 904-823-8823