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Organization
LIGHTHOUSE INTERNAL MEDICINE AND PRIMARY CARE PA
Active
Organization
LIGHTHOUSE INTERNAL MEDICINE AND PRIMARY CARE PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHONGLUN XIE (MD)
(904) 636-9510
Entity
Organization
Contact information
Practice address
5757 BOOTH RD., #200, JACKSONVILLE, FL 32207
(904) 636-9510
(904) 636-9512
Mailing address
5757 BOOTH RD BLDG 200, JACKSONVILLE, FL 32207-5981
(904) 636-9510
(904) 636-9512
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
ME92689
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009831900
—
FL
05
—
273938100
—
FL
01
—
40311
BCBS FL
FL
Enumeration date
11/01/2006
Last updated
09/21/2018
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