MEDICARE: JACK H SOLIMAN MD PA

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	302F00000X	Exclusive Provider Organization	ME0064892	FL

General Provider Information

NPI Number	:	1689942047
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JACK H SOLIMAN MD PA

Provider Business Mailing Address
First Line	:	6100 SAINT JOHNS AVE
Second Line	:	SUITE 1
City	:	PALATKA
State	:	FL
Zip	:	32177-3844
Country	:	US
Telephone Number	:	386-328-1117
Fax Number	:	386-328-0533

Provider Business Practice Location Address
First Line	:	6100 SAINT JOHNS AVE
Second Line	:	SUITE 1
City	:	PALATKA
State	:	FL
Zip	:	32177-3844
Country	:	US
Telephone Number	:	386-328-1117
Fax Number	:	386-328-0533

Authorized Official
Title or Position	:	OWNER
Name	:	JACK H SOLIMAN
Credential	:	MD PA
Telephone Number	:	386-328-1117

Provider Enumeration Date	:	12/13/2011
Last Update Date	:	12/13/2011

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Directions to “JACK H SOLIMAN MD PA ” Practice Location

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