MEDICARE: NORTH FLORIDA SURGEONS, 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	208600000X	Surgery Physician	1912953290	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	CB9176	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	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
4	40594	OTHER	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1912953290
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH FLORIDA SURGEONS, PA

Provider Business Mailing Address
First Line	:	PO BOX 14009
Second Line	:
City	:	BELFAST
State	:	ME
Zip	:	04915-4031
Country	:	US
Telephone Number	:	904-396-1725
Fax Number	:	904-399-1717

Provider Business Practice Location Address
First Line	:	11945 SAN JOSE BLVD STE 300
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32223-1627
Country	:	US
Telephone Number	:	904-396-1725
Fax Number	:	904-396-4893

Authorized Official
Title or Position	:	CEO
Name	:	MR. JOHN P BERLIN
Credential	:
Telephone Number	:	904-396-1725

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	11/24/2021

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Directions to “NORTH FLORIDA SURGEONS, PA ” Practice Location

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