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General NPI Number Information
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NPI Number | 1770575052
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Entity Type | Individual
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Provider Name | BELTON CRAIG RAY M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/22/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2627 RIVERSIDE AVE
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City | JACKSONVILLE
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State | FL
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Zip | 32204-4712
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Country | US
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Telephone | 904-308-7372
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Fax | 904-308-2998
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Provider Business Mailing Address
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Address Line | 2627 RIVERSIDE AVE
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City | JACKSONVILLE
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State | FL
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Zip | 32204-4712
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Country | US
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Telephone | 904-308-7372
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Fax | 904-308-2998
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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 | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | ME0013757
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License Number State | FL
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