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General NPI Number Information
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NPI Number | 1326403585
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Entity Type | Organization
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Legal Business Name | GENTLE CARE PODIATRY, LLC
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Dates
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Enumeration Date | 12/15/2015
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Last Update Date | 12/15/2015
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Provider Practice Location Address
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Address Line | 8450 GATE PKWY W UNIT 1504
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City | JACKSONVILLE
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State | FL
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Zip | 32216-1049
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Country | US
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Telephone | 904-738-7381
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Fax | 904-738-7259
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Provider Business Mailing Address
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Address Line | 8450 GATE PKWY W UNIT 1504
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City | JACKSONVILLE
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State | FL
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Zip | 32216-1049
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Country | US
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Telephone | 904-738-7381
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Fax | 904-738-7259
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Authorized Official
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Title or Position | C.E.O.
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Name | DR. DOMINIQUE MARIE RAMEAU
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Credential | DPM
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Telephone | 904-738-7381
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number | PO3446
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License Number State | FL
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