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General NPI Number Information
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NPI Number | 1912920372
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Entity Type | Organization
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Legal Business Name | FLORIDA PHYSICIANS & RESEARCH ASSOC
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Dates
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Enumeration Date | 07/26/2006
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Last Update Date | 05/15/2014
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Provider Practice Location Address
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Address Line | 6428 BEACH BLVD
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City | JACKSONVILLE
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State | FL
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Zip | 32216
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Country | US
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Telephone | 904-724-1717
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Fax | 904-724-1719
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Provider Business Mailing Address
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Address Line | 6428 BEACH BLVD
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City | JACKSONVILLE
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State | FL
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Zip | 32216
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Country | US
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Telephone | 904-724-1717
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Fax | 904-724-1719
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Authorized Official
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Title or Position | BILLING
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Name | MS. CONNIE A GRASSLER
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Credential |
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Telephone | 904-724-1717
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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