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General NPI Number Information
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NPI Number | 1427298363
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Entity Type | Organization
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Legal Business Name | JACKSONVILLE MULTISPECIALTY SERVICES, LLC
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Dates
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Enumeration Date | 03/05/2009
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Last Update Date | 03/05/2009
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Provider Practice Location Address
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Address Line | 1679 EAGLE HARBOR PKWY SUITE B
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City | ORANGE PARK
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State | FL
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Zip | 32003-4815
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Country | US
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Telephone | 904-399-6109
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Fax | 904-399-6626
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Provider Business Mailing Address
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Address Line | 1679 EAGLE HARBOR PKWY SUITE B
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City | ORANGE PARK
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State | FL
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Zip | 32003-4815
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | VP
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Name | WAYNE WINNEY
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Credential | VP
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Telephone | 904-399-6179
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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