MEDICARE: BEACH MEDICAL SPECIALIST 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	207R00000X	Internal Medicine Physician	ME88405	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720125479
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEACH MEDICAL SPECIALIST PA

Provider Business Mailing Address
First Line	:	9860 BEACH BLVD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32246-4704
Country	:	US
Telephone Number	:	904-200-2978
Fax Number	:	904-807-9114

Provider Business Practice Location Address
First Line	:	9860 BEACH BLVD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32246-4704
Country	:	US
Telephone Number	:	904-200-2978
Fax Number	:	904-807-9114

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ALEJANDRO CABIGTING DIZON
Credential	:	MD
Telephone Number	:	904-200-2978

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	03/06/2024

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Directions to “BEACH MEDICAL SPECIALIST PA ” Practice Location

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