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General NPI Number Information
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NPI Number | 1871702928
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Entity Type | Organization
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Legal Business Name | NE FL ENDOCRINE & DIABETES ASSOC, PA
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 05/19/2014
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Provider Practice Location Address
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Address Line | 3550 UNIVERSITY BLVD S
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City | JACKSONVILLE
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State | FL
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Zip | 32216-4246
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Country | US
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Telephone | 904-384-2240
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Fax | 904-448-0030
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Provider Business Mailing Address
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Address Line | 3550 UNIVERSITY BLVD S
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City | JACKSONVILLE
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State | FL
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Zip | 32216-4246
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Country | US
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Telephone | 904-384-2240
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Fax | 904-448-0030
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. DENA F CLAY
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Credential |
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Telephone | 904-384-2240
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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