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NPI Code Detail

MEDICARE: WIL EDVARD GERMAIN M.D.

MEDICARE: WIL EDVARD GERMAIN M.D.
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
12084P0800XPsychiatry Physician274054NY
22084P0800XPsychiatry PhysicianME137148FL
32084P0804XChild & Adolescent Psychiatry PhysicianME137148FL

Other Identifiers

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

General Provider Information

NPI Number : 1720348592
Entity Type Code : Individual
Provider Name (Legal Business Name) : WIL EDVARD GERMAIN M.D.
Provider Business Mailing Address
First Line : 12058 SAN JOSE BLVD
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32223-8666
Country : US
Telephone Number : 917-703-7002
Fax Number : 646-774-0386
Provider Business Practice Location Address
First Line : 10752 DEERWOOD PARK BLVD
Second Line : SOUTH WATERVIEW II SUITE 100
City : JACKSONVILLE
State : FL
Zip : 32256-4849
Country : US
Telephone Number : 904-755-1017
Fax Number : 646-774-0386
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/25/2012
Last Update Date : 12/18/2019

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