MEDICARE: DR. AGNES G. DAVID 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	208600000X	Surgery Physician	ME0069602	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	P00198232	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1817346	OTHER		CIGNA
2	7726223	OTHER		AETNA
3	277501	OTHER	FL	AVMED
4	35919	OTHER		BCBS FL
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497713614
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AGNES G. DAVID M. D.

Provider Business Mailing Address
First Line	:	11945 SAN JOSE BLVD
Second Line	:	BLDG 300
City	:	JACKSONVILLE
State	:	FL
Zip	:	32223-1627
Country	:	US
Telephone Number	:	904-396-1725
Fax Number	:	904-399-1717

Provider Business Practice Location Address
First Line	:	1370 13TH AVENUE
Second Line	:	SUITE 119
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-3206
Country	:	US
Telephone Number	:	904-249-4994
Fax Number	:	904-249-2604

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

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	06/23/2011

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Directions to “ DR. AGNES G. DAVID M. D.” Practice Location

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