=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366233058
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GOOD SHEPHERD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/13/2025
-----------------------------------------------------
Last Update Date | 05/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 430 COLLEGE DR STE 113-115
-----------------------------------------------------
City | MIDDLEBURG
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32068-8530
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-401-1897
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 181 SAINT JOHNS FOREST BLVD
-----------------------------------------------------
City | ST JOHNS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32259-4067
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-401-1897
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER MANAGER
-----------------------------------------------------
Name | DR. VORBES ALEGER
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 904-401-1897
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------