MEDICARE: NATURAL MEDICINE AND WELLNESS CENTER OF JACKSONVILLE, INC.

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	2083P0500X	Preventive Medicine/Occupational Environmental Medicine Physician	HCC6915	FL

General Provider Information

NPI Number	:	1760438121
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NATURAL MEDICINE AND WELLNESS CENTER OF JACKSONVILLE, INC.

Provider Business Mailing Address
First Line	:	4237 SALISBURY ROAD NORTH
Second Line	:	SUITE 110
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216
Country	:	US
Telephone Number	:	904-296-1116
Fax Number	:	904-296-1467

Provider Business Practice Location Address
First Line	:	4237 SALISBURY ROAD NORTH
Second Line	:	SUITE 110
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216
Country	:	US
Telephone Number	:	904-296-1116
Fax Number	:	904-296-1467

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. ALFONSO M BREMER
Credential	:	M.D.
Telephone Number	:	904-296-1116

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	08/22/2020

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