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General NPI Number Information
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NPI Number | 1356970065
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Entity Type | Organization
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Legal Business Name | ONSITE CONCIERGE MEDICINE GROUP LLC
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Dates
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Enumeration Date | 04/04/2020
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Last Update Date | 04/04/2020
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Provider Practice Location Address
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Address Line | 8773 PERIMETER PARK CT
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City | JACKSONVILLE
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State | FL
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Zip | 32216-1165
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Country | US
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Telephone | 704-258-7118
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Fax |
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Provider Business Mailing Address
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Address Line | 12403 CADLEY CIR
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City | JACKSONVILLE
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State | FL
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Zip | 32219-1862
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Country | US
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Telephone | 704-258-7118
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | MR. FERNANDO LEVAR GANT
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Credential |
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Telephone | 704-258-7118
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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 |
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License Number State |
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