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General NPI Number Information
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NPI Number | 1578514386
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Entity Type | Organization
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Legal Business Name | INTERNAL MEDICINE ASSOCIATES OF NORTHEAST FLORIDA PA
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Dates
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Enumeration Date | 05/15/2006
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Last Update Date | 02/21/2008
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Provider Practice Location Address
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Address Line | 1555 KINGSLEY AVE SUITE 604
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City | ORANGE PARK
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State | FL
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Zip | 32073-4560
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Country | US
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Telephone | 904-541-0670
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Fax | 904-541-0680
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Provider Business Mailing Address
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Address Line | 1555 KINGSLEY AVE SUITE 604
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City | ORANGE PARK
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State | FL
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Zip | 32073-4560
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Country | US
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Telephone | 904-541-0670
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Fax | 904-541-0680
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MRS. JENNIFER LYN MCLEAN
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Credential |
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Telephone | 904-541-0702
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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