# CARTE BLANCHE HOLDINGS, INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Medi Weightloss
- **Organization subpart:** No

## Provider details

- **NPI number:** 1558730085
- **Authorized official:** MR. BLAKE A KOZOL (PRESIDENT)
- **Authorized official phone:** (904) 625-0038

## Contact information

- **Practice address:** 13546 BEACH BLVD, UNIT 2, JACKSONVILLE, FL 32224-7232
- **Practice address phone:** (904) 574-5000
- **Mailing address:** 1626 N LIBERTY ST, JACKSONVILLE, FL 32206-4649
- **Mailing address phone:** (904) 625-0038

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QB0002X | Obesity Medicine (Family Medicine) Physician | ME42368 | FL | Yes |
| 207RB0002X | Obesity Medicine (Internal Medicine) Physician | — | NULL | — |
| 207RB0002X | Obesity Medicine (Internal Medicine) Physician | — | — | — |
| 207VB0002X | Obesity Medicine (Obstetrics & Gynecology) Physician | — | NULL | — |
| 207VB0002X | Obesity Medicine (Obstetrics & Gynecology) Physician | — | — | — |

## Other

- **Enumeration date:** 09/15/2015
- **Last updated:** 09/15/2015