MEDICARE: DR. JUSTIN MICHAEL MORTIMER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	ME154109	FL
2	390200000X	Student in an Organized Health Care Education/Training Program

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013277656
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUSTIN MICHAEL MORTIMER MD

Provider Business Mailing Address
First Line	:	2732 TROLLIE LN
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32211-3833
Country	:	US
Telephone Number	:	904-289-1254
Fax Number	:

Provider Business Practice Location Address
First Line	:	2732 TROLLIE LN
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32211-3833
Country	:	US
Telephone Number	:	904-289-1254
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2012
Last Update Date	:	05/30/2024

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