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General NPI Number Information
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NPI Number | 1174673859
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Entity Type | Organization
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Legal Business Name | DRS BAKER & GILMOUR MD PA
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Dates
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Enumeration Date | 01/12/2007
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Last Update Date | 12/11/2013
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Provider Practice Location Address
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Address Line | 300 HEALTH PARK BLVD SUITE 1006
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City | ST AUGUSTINE
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State | FL
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Zip | 32086-3707
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Country | US
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Telephone | 904-794-7050
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Fax |
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Provider Business Mailing Address
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Address Line | 3550 UNIVERSITY BLVD S SUITE 302
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City | JACKSONVILLE
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State | FL
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Zip | 32216-4246
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Country | US
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Telephone | 904-733-4444
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Fax |
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | MR. JODY BOSTIC
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Credential |
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Telephone | 904-733-4444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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