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General NPI Number Information
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NPI Number | 1265840771
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Entity Type | Organization
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Legal Business Name | LONDON OBSTETRIC AND GYNECOLOGIC SERVICES, PA
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Dates
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Enumeration Date | 07/28/2014
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Last Update Date | 07/28/2014
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Provider Practice Location Address
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Address Line | 4114 SUNBEAM RD BUILDING 100, SUITE 102
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City | JACKSONVILLE
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State | FL
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Zip | 32257-8847
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Country | US
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Telephone | 904-880-1400
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Fax | 904-886-4433
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Provider Business Mailing Address
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Address Line | 4114 SUNBEAM RD BUILDING 100, SUITE 102
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City | JACKSONVILLE
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State | FL
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Zip | 32257-8847
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Country | US
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Telephone | 904-880-1400
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Fax | 904-886-4433
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BEVERLY MINOLTA LONDON
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Credential | M.D.
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Telephone | 904-880-1400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | ME0073682
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License Number State | FL
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