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General NPI Number Information
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NPI Number | 1235232273
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Entity Type | Organization
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Legal Business Name | NORTHEAST FLORIDA PRIMARY CARE CLINIC
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Dates
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Enumeration Date | 09/06/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 1835 EAST-WEST PARKWAY SUITE 11
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City | ORANGE PARK
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State | FL
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Zip | 32003
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Country | US
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Telephone | 904-215-9266
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Fax | 904-264-4651
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Provider Business Mailing Address
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Address Line | 1835 EAST-WEST PARKWAY SUITE 11
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City | ORANGE PARK
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State | FL
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Zip | 32003
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Country | US
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Telephone | 904-215-9266
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Fax | 904-264-4651
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JACK EDWARD PULWERS JR.
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Credential | MD
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Telephone | 904-215-9266
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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 | ME0068123
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME0076341
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License Number State | FL
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