MEDICARE: INTERNAL MEDICINE OF JACKSONVILLE

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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1043279680
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERNAL MEDICINE OF JACKSONVILLE

Provider Business Mailing Address
First Line	:	1201 MONUMENT RD
Second Line	:	STE 201
City	:	JACKSONVILLE
State	:	FL
Zip	:	32225
Country	:	US
Telephone Number	:	904-727-5151
Fax Number	:	904-727-7714

Provider Business Practice Location Address
First Line	:	1201 MONUMENT RD
Second Line	:	STE 201
City	:	JACKSONVILLE
State	:	FL
Zip	:	32225-7411
Country	:	US
Telephone Number	:	904-727-5151
Fax Number	:	904-727-7714

Authorized Official
Title or Position	:	OWNER
Name	:	DR. OSCAR ENRIQUE RODOS
Credential	:	MD
Telephone Number	:	904-727-5151

Provider Enumeration Date	:	03/22/2006
Last Update Date	:	10/31/2007

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