# FLAGLER FAMILY MEDICINE P A

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1215080809
- **Authorized official:** MRS. RUTH J FAIRCLOTH (ACCOUNTS RECEVIABLE MANAGER)
- **Authorized official phone:** (904) 826-3469

## Contact information

- **Practice address:** 130 HEALTH PARK BLVD, ST AUGUSTINE, FL 32086-5776
- **Practice address phone:** (904) 826-3469
- **Practice address fax:** (904) 808-4608
- **Mailing address:** 130 HEALTH PARK BLVD, ST AUGUSTINE, FL 32086-5776
- **Mailing address phone:** (904) 826-3469
- **Mailing address fax:** (904) 808-4608

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 01/19/2007
- **Last updated:** 07/23/2008