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General NPI Number Information
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NPI Number | 1023522315
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Entity Type | Organization
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Legal Business Name | RELIANCE MEDICAL ASSOCIATES OF JAX LLC
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Dates
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Enumeration Date | 11/22/2017
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Last Update Date | 07/10/2023
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Provider Practice Location Address
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Address Line | 8833 PERIMETER PARK BLVD STE 503
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City | JACKSONVILLE
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State | FL
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Zip | 32216-1110
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Country | US
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Telephone | 904-687-1055
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Fax | 904-687-2141
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Provider Business Mailing Address
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Address Line | 2220 COUNTY ROAD 210 W STE 108 PMB 257
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City | ST JOHNS
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State | FL
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Zip | 32259-4060
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Country | US
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Telephone | 321-506-3925
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. VISHAL C PATEL
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Credential | MD
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Telephone | 321-506-3925
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | ME121788
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | ME121788
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME121788
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME121788
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License Number State | FL
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