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General NPI Number Information
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NPI Number | 1811472152
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Entity Type | Organization
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Legal Business Name | ORTHO ONE
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Dates
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Enumeration Date | 10/02/2018
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Last Update Date | 09/20/2021
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Provider Practice Location Address
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Address Line | 6100 KENNERLY RD STE 202
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City | JACKSONVILLE
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State | FL
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Zip | 32216-4379
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Country | US
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Telephone | 904-619-3048
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Fax | 904-619-5753
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Provider Business Mailing Address
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Address Line | 6100 KENNERLY RD STE 202
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City | JACKSONVILLE
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State | FL
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Zip | 32216-4379
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MD
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Name | FADY EL-BAHRI
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Credential | MD
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Telephone | 904-536-8331
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number |
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License Number State |
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