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General NPI Number Information
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NPI Number | 1740463496
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Entity Type | Organization
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Legal Business Name | RICARDO BUDJAK MD PA
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Dates
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Enumeration Date | 12/17/2007
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Last Update Date | 05/18/2011
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Provider Practice Location Address
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Address Line | 2574 HERSCHEL ST
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City | JACKSONVILLE
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State | FL
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Zip | 32204-4556
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Country | US
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Telephone | 904-389-3581
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Fax |
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Provider Business Mailing Address
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Address Line | 2574 HERSCHEL ST
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City | JACKSONVILLE
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State | FL
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Zip | 32204-4556
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Country | US
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Telephone | 904-389-3581
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. RUTH BUDJAK
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Credential |
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Telephone | 904-389-3581
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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 | ME73074
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License Number State | FL
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