MEDICARE: MCCAULIE PRIMARY CARE P A

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	207Q00000X	Family Medicine Physician	ME 000054470	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	:	1417083171
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCCAULIE PRIMARY CARE P A

Provider Business Mailing Address
First Line	:	520 A1A N
Second Line	:	SUITE 201
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32082-5212
Country	:	US
Telephone Number	:	904-280-5700
Fax Number	:	904-280-5703

Provider Business Practice Location Address
First Line	:	520 A1A N
Second Line	:	SUITE 201
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32082-5212
Country	:	US
Telephone Number	:	904-280-5700
Fax Number	:	904-280-5703

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOHN ROBERT MCCAULIE
Credential	:	MD
Telephone Number	:	904-280-5700

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	04/05/2011

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Directions to “MCCAULIE PRIMARY CARE P A ” Practice Location

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