=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699853044
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ARTHRITIS & RHEUMATOLOGY CLINIC PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/02/2006
-----------------------------------------------------
Last Update Date | 01/12/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2119 OAK ST
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32204-4410
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-389-2707
-----------------------------------------------------
Fax | 904-389-7009
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2119 OAK ST
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32204-4410
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-389-2707
-----------------------------------------------------
Fax | 904-389-7009
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | BSHARA BARAKAT
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 904-389-2707
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | ME75096
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | ME68949
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------