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General NPI Number Information
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NPI Number | 1043346745
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Entity Type | Organization
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Legal Business Name | JACKSONVILLE PEDIATRICS
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2606 PARK ST
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City | JACKSONVILLE
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State | FL
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Zip | 32204-4520
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Country | US
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Telephone | 904-388-4646
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Fax | 904-388-9071
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Provider Business Mailing Address
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Address Line | 2606 PARK ST
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City | JACKSONVILLE
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State | FL
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Zip | 32204-4520
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Country | US
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Telephone | 904-388-4646
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Fax | 904-388-9071
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Authorized Official
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Title or Position | SENIOR PHYSICIAN
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Name | DR. RANDOLPH EDENS THORNTON
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Credential | M.D.
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Telephone | 904-389-4140
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number |
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License Number State | FL
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