MEDICARE: MEDICAL EXAMINER'S OFFICE

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	174400000X	Specialist	ME#39222	FL

General Provider Information

NPI Number	:	1457625071
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL EXAMINER'S OFFICE

Provider Business Mailing Address
First Line	:	2100 JEFFERSON ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32206-3534
Country	:	US
Telephone Number	:	904-255-4000
Fax Number	:	904-630-8251

Provider Business Practice Location Address
First Line	:	2100 JEFFERSON ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32206-3534
Country	:	US
Telephone Number	:	904-255-4000
Fax Number	:	904-630-8251

Authorized Official
Title or Position	:	CHIEF MEDICAL EXAMINER
Name	:	DR. VALERIE J RAO
Credential	:	MD
Telephone Number	:	904-255-4000

Provider Enumeration Date	:	02/29/2012
Last Update Date	:	02/29/2012

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