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General NPI Number Information
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NPI Number | 1083843288
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Entity Type | Organization
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Legal Business Name | FAMILY MEDICAL CARE OF ST AUGUSTINE PA
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Dates
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Enumeration Date | 07/08/2009
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Last Update Date | 07/08/2009
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Provider Practice Location Address
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Address Line | 244 SOUTHPARK CIR E
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City | ST AUGUSTINE
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State | FL
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Zip | 32086-5137
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Country | US
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Telephone | 904-824-7773
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Fax |
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Provider Business Mailing Address
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Address Line | 244 SOUTHPARK CIR E
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City | ST AUGUSTINE
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State | FL
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Zip | 32086-5137
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Country | US
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Telephone | 904-824-7773
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JIGNESH PATEL
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Credential | MD
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Telephone | 904-824-7773
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME0071614
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License Number State | FL
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