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General NPI Number Information
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NPI Number | 1609093426
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Entity Type | Organization
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Legal Business Name | VLADIMIR HAVRYLIUK M D P A
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Dates
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Enumeration Date | 04/20/2007
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 8818 ARLINGTON EXPY B
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City | JACKSONVILLE
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State | FL
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Zip | 32211-8071
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Country | US
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Telephone | 904-221-0014
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Fax | 904-221-9189
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Provider Business Mailing Address
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Address Line | 13714 BROMLEY POINT DR
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City | JACKSONVILLE
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State | FL
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Zip | 32225-2634
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Country | US
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Telephone | 904-220-9448
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | VLADIMIR HAVRYLIUK
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Credential | M.D.
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Telephone | 904-221-0014
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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 | ME86747
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License Number State | FL
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