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General NPI Number Information
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NPI Number | 1508851270
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Entity Type | Organization
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Legal Business Name | NORTH FLORIDA CENTER FOR PREVENTIVE MEDICINE PA
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Dates
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Enumeration Date | 09/19/2005
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Last Update Date | 01/17/2013
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Provider Practice Location Address
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Address Line | 14546 OLD SAINT AUGUSTINE RD SUITE 211
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City | JACKSONVILLE
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State | FL
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Zip | 32258-5468
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Country | US
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Telephone | 904-268-5590
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Fax | 904-268-8305
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Provider Business Mailing Address
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Address Line | 14546 OLD SAINT AUGUSTINE RD SUITE 211
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City | JACKSONVILLE
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State | FL
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Zip | 32258-5468
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Country | US
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Telephone | 904-268-5590
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Fax | 904-268-8305
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | DR. JOHN KALAM
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Credential | MD
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Telephone | 904-268-5590
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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