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General NPI Number Information
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NPI Number | 1972745172
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Entity Type | Organization
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Legal Business Name | OCEANSHORE FAMILY MEDICAL CENTER, PLLC
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Dates
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Enumeration Date | 04/02/2009
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Last Update Date | 04/02/2009
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Provider Practice Location Address
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Address Line | 811 N OCEANSHORE BLVD
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City | FLAGLER BEACH
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State | FL
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Zip | 32136-3308
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Country | US
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Telephone | 386-439-4224
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Fax |
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Provider Business Mailing Address
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Address Line | 811 N OCEANSHORE BLVD
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City | FLAGLER BEACH
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State | FL
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Zip | 32136-3308
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Country | US
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Telephone | 386-439-4224
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Fax |
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Authorized Official
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Title or Position | MANAGER/MBR
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Name | DR. JILL KERR
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Credential | D.O.
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Telephone | 386-439-4224
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS10190
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License Number State | FL
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