Organization
MAINLAND PHYSICIANS GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN PAUL JAMES SHADDOCK (DIRECTOR OF NETWORK MANAGMENT)
(850) 341-6322
Entity
Organization
Contact information
Practice address
100 ARRICOLA AVE, ST AUGUSTINE, FL 32080-4515
(904) 825-4368
(904) 825-9107
Mailing address
100 ARRICOLA AVE, ST AUGUSTINE, FL 32080-4515
(904) 825-4368
(904) 825-9107
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
—
—
Other
Enumeration date
11/17/2020
Last updated
11/17/2020
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