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General NPI Number Information
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NPI Number | 1669964722
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Entity Type | Organization
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Legal Business Name | BAPTIST CARDIOLOGY INC
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Dates
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Enumeration Date | 06/05/2018
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Last Update Date | 06/05/2018
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Provider Practice Location Address
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Address Line | 533 W TWINCOURT TRL STE 701&702
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City | ST AUGUSTINE
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State | FL
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Zip | 32095-8884
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Country | US
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Telephone | 904-940-6057
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Fax | 904-940-7601
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Provider Business Mailing Address
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Address Line | PO BOX 43667
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City | JACKSONVILLE
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State | FL
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Zip | 32203-3667
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Country | US
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Telephone | 904-720-0599
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Fax | 904-376-4036
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Authorized Official
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Title or Position | ADMINSTRATOR
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Name | MARK MASTERS
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Credential | PHD
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Telephone | 904-391-0058
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State | FL
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