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NPI Code Detail

MEDICARE: OTOLARYNGOLOGY SURGICAL ASSOCIATES

MEDICARE: OTOLARYNGOLOGY SURGICAL ASSOCIATES
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
1207Y00000XOtolaryngology PhysicianME15432FL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1CA2610OTHERFLRR MEDICARE

General Provider Information

NPI Number : 1518941764
Entity Type Code : Organization
Provider Name (Legal Business Name) : OTOLARYNGOLOGY SURGICAL ASSOCIATES
Provider Business Mailing Address
First Line : 2035 PROFESSIONAL CENTER DR
Second Line : SUITE A
City : ORANGE PARK
State : FL
Zip : 32073-4492
Country : US
Telephone Number : 904-272-3200
Fax Number : 904-272-3211
Provider Business Practice Location Address
First Line : 2035 PROFESSIONAL CENTER DR
Second Line : SUITE A
City : ORANGE PARK
State : FL
Zip : 32073-4492
Country : US
Telephone Number : 904-272-3200
Fax Number : 904-272-3211
Authorized Official
Title or Position : PHYSICIAN
Name : DR. JOSEPH A. RUGGIERO
Credential : M.D.
Telephone Number : 904-272-3200
Provider Enumeration Date : 12/01/2005
Last Update Date : 08/22/2020

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