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General NPI Number Information
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NPI Number | 1891009262
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Entity Type | Organization
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Legal Business Name | NAVAL HOSPITAL JACKSONVILLE
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Dates
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Enumeration Date | 07/28/2010
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Last Update Date | 07/28/2010
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Provider Practice Location Address
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Address Line | 2080 CHILD ST
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City | JACKSONVILLE
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State | FL
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Zip | 32214-5000
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Country | US
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Telephone | 904-542-9790
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Fax |
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Provider Business Mailing Address
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Address Line | 2080 CHILD ST
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City | JACKSONVILLE
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State | FL
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Zip | 32214-5000
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Country | US
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Telephone | 904-542-9790
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Fax |
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Authorized Official
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Title or Position | FAMILY MEDICINE INTERN
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Name | DR. MARIE ELIZABETH BROCK
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Credential | D.O.
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Telephone | 423-718-7850
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 286500000X
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Taxonomy Name | Military Hospital
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License Number |
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License Number State |
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