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Organization
INSTITUTE OF INTERNAL MEDICINE P A
Active
Organization
INSTITUTE OF INTERNAL MEDICINE P A
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARMEN C VIVERO MD (PRESIDENT)
(904) 460-0707
Entity
Organization
Contact information
Practice address
1301 PLANTATION ISLAND DR S, STE 402B, ST AUGUSTINE, FL 32080-3108
(904) 460-0707
Mailing address
1301 PLANTATION ISLAND DR S, STE 402-B, ST AUGUSTINE, FL 32080-3108
(904) 460-0707
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
ME76599
FL
207RA0401X
Addiction Medicine (Internal Medicine) Physician
ME76599
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003271700
—
FL
01
—
44784
BCBS
FL
01
—
DN9360
RR MEDICARE
FL
Enumeration date
03/24/2008
Last updated
09/15/2011
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