MEDICARE: MEDIFIRST-MEDIFAST, 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	207R00000X	Internal Medicine Physician	ME0026098	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1952336083
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDIFIRST-MEDIFAST, INC

Provider Business Mailing Address
First Line	:	1718 N EDGEWOOD AVE
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32254
Country	:	US
Telephone Number	:	904-781-6203
Fax Number	:	904-781-6207

Provider Business Practice Location Address
First Line	:	1718 N EDGEWOOD AVE
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32254
Country	:	US
Telephone Number	:	904-781-6203
Fax Number	:	904-781-6207

Authorized Official
Title or Position	:	OWNER/PHYSICIAN
Name	:	JUAN FELIPE GARCIA
Credential	:	MD
Telephone Number	:	904-781-6203

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	11/14/2014

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Directions to “MEDIFIRST-MEDIFAST, INC ” Practice Location

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