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General NPI Number Information
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NPI Number | 1194773812
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Entity Type | Organization
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Legal Business Name | HYPERBARIC OXYGEN SPECIALIST
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Dates
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Enumeration Date | 05/05/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3901 UNIVERSITY BLVD S SUITE 221
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City | JACKSONVILLE
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State | FL
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Zip | 32216-4377
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Country | US
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Telephone | 904-391-1206
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 919049
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City | ORLANDO
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State | FL
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Zip | 32891-9049
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | FREDERICK K VONTZ
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Credential | MD
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Telephone | 904-399-1206
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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 | ME10390
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License Number State | FL
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