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General NPI Number Information
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NPI Number | 1013391275
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Entity Type | Organization
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Legal Business Name | BEACHES EAR, NOSE AND THROAT, PA
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Dates
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Enumeration Date | 07/16/2015
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Last Update Date | 07/16/2015
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Provider Practice Location Address
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Address Line | 3200 3RD ST S SUITE 101
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City | JACKSONVILLE BEACH
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State | FL
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Zip | 32250-6096
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Country | US
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Telephone | 904-247-4070
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Fax | 904-247-4131
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Provider Business Mailing Address
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Address Line | PO BOX 3217
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City | PONTE VEDRA BEACH
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State | FL
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Zip | 32004-3217
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Country | US
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Telephone | 904-247-4070
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Fax | 904-247-4131
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Authorized Official
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Title or Position | OWNER
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Name | DR. JEFFREY E BRINK
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Credential | M.D.
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Telephone | 904-247-4070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231HA2400X
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Taxonomy Name | Assistive Technology Practitioner Audiologist
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License Number | AY1951
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License Number State | FL
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