MEDICARE: DR. MARC EDWARD TAFFLIN D.O.

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	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	OS3659	FL

General Provider Information

NPI Number	:	1790704153
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARC EDWARD TAFFLIN D.O.

Provider Business Mailing Address
First Line	:	104 LINKSIDE CIR
Second Line	:
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32082-2031
Country	:	US
Telephone Number	:	904-273-4450
Fax Number	:	904-273-2188

Provider Business Practice Location Address
First Line	:	1820 BARRS ST
Second Line	:	SUITE 601
City	:	JACKSONVILLE
State	:	FL
Zip	:	32204-4742
Country	:	US
Telephone Number	:	904-384-8444
Fax Number	:	904-308-6089

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	07/08/2007

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