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Organization
CARDIOTHORACIC & VASCULAR SURGICAL ASSOCIATES PA
Active
Organization
CARDIOTHORACIC & VASCULAR SURGICAL ASSOCIATES PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LARRY TAYLOR (PRESIDENT)
(052) 790-1732
Entity
Organization
Contact information
Practice address
1824 KING ST, STE 200, JACKSONVILLE, FL 32204-4735
(904) 384-3343
(904) 400-6671
Mailing address
1824 KING ST, STE 200, JACKSONVILLE, FL 32204-4735
(904) 384-3343
(904) 400-6671
Taxonomy
Speciality
Code
Description
License number
State
202K00000X
Phlebology Physician
—
—
207RC0000X
Cardiovascular Disease Physician
—
—
207RI0011X
Interventional Cardiology Physician
—
—
2085R0202X
Diagnostic Radiology Physician
—
—
2085R0204X
Vascular & Interventional Radiology Physician
Primary
—
—
208600000X
Surgery Physician
—
—
2086S0129X
Vascular Surgery Physician
—
—
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
251834100
—
FL
01
—
CC8211
MEDICARE RAILROAD
—
Enumeration date
08/31/2006
Last updated
04/17/2025
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