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General NPI Number Information
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NPI Number | 1588604870
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Entity Type | Individual
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Provider Name | STEVEN BENJAMIN KAILES M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/07/2006
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Last Update Date | 10/15/2008
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Provider Practice Location Address
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Address Line | 2001 KINGSLEY AVE ORANGE PARK MEDICAL CENTER EMERGENCY DEPARTMENT
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City | ORANGE PARK
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State | FL
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Zip | 32073-5148
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Country | US
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Telephone | 904-276-8580
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Fax |
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Provider Business Mailing Address
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Address Line | 8761 PERIMETER PARK BLVD STE 106 SOUTHEAST EMERGENCY CONSULTANTS
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City | JACKSONVILLE
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State | FL
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Zip | 32216-6397
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Country | US
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Telephone | 904-641-6628
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Fax | 904-642-1243
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | ME91282
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License Number State | FL
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