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General NPI Number Information
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NPI Number | 1992081715
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Entity Type | Organization
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Legal Business Name | MEDICAL PARTNERS OF JACKSONVILLE LLC
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Dates
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Enumeration Date | 10/25/2011
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Last Update Date | 10/25/2011
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Provider Practice Location Address
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Address Line | 6269 BEACH BLVD
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City | JACKSONVILLE
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State | FL
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Zip | 32216-2768
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Country | US
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Telephone | 904-458-7246
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Fax | 904-743-3087
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Provider Business Mailing Address
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Address Line | 6269 BEACH BLVD
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City | JACKSONVILLE
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State | FL
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Zip | 32216-2768
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Country | US
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Telephone | 904-458-7246
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Fax | 904-743-3087
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Authorized Official
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Title or Position | PRESIDENT
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Name | HEMANT SHAH
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Credential | MD
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Telephone | 904-458-7246
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | ME95262
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License Number State | FL
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