MEDICARE: DR. DAVID OMER CHILDERS JR. 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	208000000X	Pediatrics Physician	ME86363	FL
2	2080P0008X	Pediatric Neurodevelopmental Disabilities Physician	ME86363	FL
3	2080P0006X	Developmental - Behavioral Pediatrics Physician	ME86363	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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467493288
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID OMER CHILDERS JR. M.D.

Provider Business Mailing Address
First Line	:	PO BOX 44008
Second Line	:	UFJP PROVIDER ENROLLMENT
City	:	JACKSONVILLE
State	:	FL
Zip	:	32231-4008
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6271 SAINT AUGUSTINE RD
Second Line	:	UFJP DEVELOPMENTAL PEDIATRICS
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-2523
Country	:	US
Telephone Number	:	904-633-0770
Fax Number	:	904-633-0751

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

Provider Enumeration Date	:	06/10/2006
Last Update Date	:	12/13/2019

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Directions to “ DR. DAVID OMER CHILDERS JR. M.D.” Practice Location

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