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NPI Code Detail

MEDICARE: NORTH FLORIDA MEDICAL GROUP, LLC

MEDICARE: NORTH FLORIDA MEDICAL GROUP, LLC
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
1208200000XPlastic Surgery Physician
2208600000XSurgery Physician
3363LF0000XFamily Nurse Practitioner
4207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1518287036
Entity Type Code : Organization
Provider Name (Legal Business Name) : NORTH FLORIDA MEDICAL GROUP, LLC
Provider Business Mailing Address
First Line : 1702 OHIO AVE
Second Line :
City : LYNN HAVEN
State : FL
Zip : 32444-4290
Country : US
Telephone Number : 850-571-5844
Fax Number : 850-571-5845
Provider Business Practice Location Address
First Line : 1702 OHIO AVE
Second Line :
City : LYNN HAVEN
State : FL
Zip : 32444-4290
Country : US
Telephone Number : 850-571-5844
Fax Number : 850-571-5845
Authorized Official
Title or Position : PRES/CEO
Name : MR. WILLIAM R RHODES JR.
Credential : ARNP
Telephone Number : 850-571-5844
Provider Enumeration Date : 06/07/2010
Last Update Date : 07/19/2012

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Directions to “NORTH FLORIDA MEDICAL GROUP, LLC ” Practice Location

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