MEDICARE: FLORIDA MEDICAL GERIATRIC GROUP

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	ME102175	FL

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	:	1043756588
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORIDA MEDICAL GERIATRIC GROUP

Provider Business Mailing Address
First Line	:	181 SAINT JOHNS FOREST BLVD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32259-4067
Country	:	US
Telephone Number	:	904-401-1897
Fax Number	:	904-808-7118

Provider Business Practice Location Address
First Line	:	2220 COUNTY ROAD 210 W
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32259-4058
Country	:	US
Telephone Number	:	904-401-1897
Fax Number	:	904-808-7118

Authorized Official
Title or Position	:	OWNER
Name	:	DR. VORBES ALEGER
Credential	:	M.D.
Telephone Number	:	904-401-1897

Provider Enumeration Date	:	01/08/2017
Last Update Date	:	01/08/2017

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