MEDICARE: NEUROLOGY ASSOCIATES OF NORTH FLORIDA , INC

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	2084N0400X	Neurology Physician	ME62533	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DD6330	OTHER		R.R. MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	33708	OTHER	FL	BCBS

General Provider Information

NPI Number	:	1104863042
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEUROLOGY ASSOCIATES OF NORTH FLORIDA , INC

Provider Business Mailing Address
First Line	:	PO BOX 17809
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32245-7809
Country	:	US
Telephone Number	:	904-723-0015
Fax Number	:	904-338-0951

Provider Business Practice Location Address
First Line	:	1361 13TH AVE S STE 170A
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-3235
Country	:	US
Telephone Number	:	904-249-4456
Fax Number	:	904-249-7703

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RICHARD BOEHME
Credential	:	MD
Telephone Number	:	904-249-4456

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	01/24/2012

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