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General NPI Number Information
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NPI Number | 1811066103
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Entity Type | Organization
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Legal Business Name | JACKSONVILLE INTERNAL MEDICINE
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 01/11/2012
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Provider Practice Location Address
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Address Line | 2270 PELHAM RD S
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City | JACKSONVILLE
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State | AL
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Zip | 36265-9582
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Country | US
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Telephone | 256-435-5499
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Fax | 256-435-6064
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Provider Business Mailing Address
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Address Line | PO BOX 550
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City | JACKSONVILLE
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State | AL
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Zip | 36265
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Country | US
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Telephone | 256-435-5499
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Fax | 256-435-6064
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Authorized Official
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Title or Position | OWNER
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Name | DR. REY GAVINO
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Credential |
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Telephone | 256-435-5499
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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 | 25404
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License Number State | AL
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