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General NPI Number Information
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NPI Number | 1942515804
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Entity Type | Organization
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Legal Business Name | 30 MINUTE MEDICAL PRIMARY CARE
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Dates
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Enumeration Date | 08/16/2010
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Last Update Date | 08/25/2010
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Provider Practice Location Address
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Address Line | 8540 ARGYLE FOREST BLVD SUITE 6
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City | JACKSONVILLE
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State | FL
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Zip | 32244-6702
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Country | US
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Telephone | 904-777-1650
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Fax | 904-777-1665
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Provider Business Mailing Address
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Address Line | 8540 ARGYLE FOREST BLVD. SUITE 6
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City | JACKSONVILLE
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State | FL
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Zip | 32244-6314
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Country | US
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Telephone | 904-777-1650
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Fax | 904-777-1665
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | DR. BIAGIO V VULTAGGIO
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Credential | M.D.
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Telephone | 904-777-1650
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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 | ME96271
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License Number State | FL
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