MEDICARE: MR. JEFFREY D. CAUDILL M.D.

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	207LP2900X	Pain Medicine (Anesthesiology) Physician	ME88799	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
2	48119	OTHER	FL	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326144700
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEFFREY D. CAUDILL M.D.

Provider Business Mailing Address
First Line	:	5851 TIMUQUANA RD
Second Line	:	SUITE 401
City	:	JACKSONVILLE
State	:	FL
Zip	:	32210-7878
Country	:	US
Telephone Number	:	904-317-5069
Fax Number	:

Provider Business Practice Location Address
First Line	:	5851 TIMUQUANA RD
Second Line	:	SUITE 401
City	:	JACKSONVILLE
State	:	FL
Zip	:	32210-7878
Country	:	US
Telephone Number	:	904-317-5069
Fax Number	:

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

Provider Enumeration Date	:	09/15/2006
Last Update Date	:	12/02/2009

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