MEDICARE: TAOLIN C JEN 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	261QP2300X	Primary Care Clinic/Center	P93000013252	FL

General Provider Information

NPI Number	:	1881912061
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAOLIN C JEN MD PA

Provider Business Mailing Address
First Line	:	3 SHIRCLIFF WAY
Second Line	:	SUITE 614
City	:	JACKSONVILLE
State	:	FL
Zip	:	32204-4776
Country	:	US
Telephone Number	:	904-387-9033
Fax Number	:	904-387-9561

Provider Business Practice Location Address
First Line	:	3 SHIRCLIFF WAY
Second Line	:	SUITE 614
City	:	JACKSONVILLE
State	:	FL
Zip	:	32204-4776
Country	:	US
Telephone Number	:	904-387-9033
Fax Number	:	904-387-9561

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TAOLIN C JEN
Credential	:	M.D.
Telephone Number	:	904-387-9033

Provider Enumeration Date	:	05/12/2010
Last Update Date	:	05/12/2010

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