| NPI | 1306515523 |
|---|---|
| Other Name | JAX 2606 PARK ST |
| Entity Type | Organization |
| Authorized Contact | LORA MORSE VP Professional Fee Services 321-434-6116 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics |
| Enumeration Date | 2021-09-10 |
| Last Update Date | 2021-09-10 |