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Organization
JACKSONVILLE PHYSICAL MEDICINE LLC
Active
Organization
JACKSONVILLE PHYSICAL MEDICINE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEREMIAH W. CARLSON (OWNER)
(904) 619-2703
Entity
Organization
Contact information
Practice address
7860 GATE PKWY STE 106, JACKSONVILLE, FL 32256-7280
(904) 619-2703
(904) 619-2837
Mailing address
7860 GATE PKWY STE 106, JACKSONVILLE, FL 32256-7280
(904) 619-2703
(904) 619-2837
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
ME88018
FL
363L00000X
Nurse Practitioner
ARNP9278608
FL
Other
Enumeration date
01/21/2013
Last updated
01/21/2013
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