MEDICARE: NAVARRE MEDICAL 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
1	208000000X	Pediatrics Physician	ME 93028	FL
2	207R00000X	Internal Medicine Physician	ME 93028	FL

General Provider Information

NPI Number	:	1528256260
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NAVARRE MEDICAL ASSOCIATES

Provider Business Mailing Address
First Line	:	8740 ORTEGA PARK DR
Second Line	:
City	:	NAVARRE
State	:	FL
Zip	:	32566-4139
Country	:	US
Telephone Number	:	850-936-6211
Fax Number	:

Provider Business Practice Location Address
First Line	:	8740 ORTEGA PARK DR
Second Line	:
City	:	NAVARRE
State	:	FL
Zip	:	32566-4139
Country	:	US
Telephone Number	:	850-936-6211
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JEFFREY G. ELLINGTON
Credential	:	MD
Telephone Number	:	850-936-6211

Provider Enumeration Date	:	10/09/2007
Last Update Date	:	10/09/2007

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Practice Location Address:

8754 ORTEGA PARK DR
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Practice Location Address:

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Practice Location Address:

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Practice Location Address:

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32566-4139

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Directions to “NAVARRE MEDICAL ASSOCIATES ” Practice Location

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