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General NPI Number Information
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NPI Number | 1215080809
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Entity Type | Organization
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Legal Business Name | FLAGLER FAMILY MEDICINE P A
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Dates
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Enumeration Date | 01/19/2007
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Last Update Date | 07/23/2008
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Provider Practice Location Address
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Address Line | 130 HEALTH PARK BLVD
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City | ST AUGUSTINE
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State | FL
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Zip | 32086-5776
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Country | US
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Telephone | 904-826-3469
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Fax | 904-808-4608
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Provider Business Mailing Address
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Address Line | 130 HEALTH PARK BLVD
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City | ST AUGUSTINE
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State | FL
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Zip | 32086-5776
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Country | US
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Telephone | 904-826-3469
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Fax | 904-808-4608
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Authorized Official
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Title or Position | ACCOUNTS RECEVIABLE MANAGER
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Name | MRS. RUTH J FAIRCLOTH
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Credential |
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Telephone | 904-826-3469
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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