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Organization
NH JAX
Active
Organization
NH JAX
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAQUEL BONO (COMMANDING OFFICER)
(904) 542-7300
Entity
Organization
Contact information
Practice address
2080 CHILD ST, JACKSONVILLE, FL 32214-5005
(904) 542-7975
(904) 542-7394
Mailing address
627 CARRACK DR, SAINT MARYS, GA 31558-2600
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
A64120
CA
Other
Enumeration date
01/19/2006
Last updated
07/17/2008
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