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General NPI Number Information
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NPI Number | 1164738191
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Entity Type | Organization
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Legal Business Name | VILLAGE PEDIATRICS OF ST AUGUSTINE LLC
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Dates
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Enumeration Date | 08/27/2010
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Last Update Date | 08/27/2010
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Provider Practice Location Address
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Address Line | 319 W TOWN PL SUITE 1
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City | ST AUGUSTINE
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State | FL
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Zip | 32092-3101
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Country | US
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Telephone | 904-940-1577
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Fax | 904-940-1916
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Provider Business Mailing Address
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Address Line | 319 W TOWN PL SUITE 1
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City | ST AUGUSTINE
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State | FL
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Zip | 32092-3101
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Country | US
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Telephone | 904-940-1577
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Fax | 904-940-1916
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Authorized Official
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Title or Position | OWNER
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Name | DR. PATRICIA ELVIR
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Credential | M.D.
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Telephone | 904-940-1577
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | ME93245
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License Number State | FL
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