| NPI | 1265772370 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH ELLYSON Office Manager 904-475-2039 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 103T00000X Psychologist |
| 204C00000X Neuromusculoskeletal Medicine, Sports Medicine | |
| 207Q00000X Family Medicine | |
| 208VP0000X Pain Medicine, Pain Medicine | |
| 213E00000X Podiatrist | |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| 261QP1100X Clinic/Center, Podiatric | |
| Enumeration Date | 2013-02-26 |
| Last Update Date | 2024-03-06 |