Organization
KIDS CARE PEDIATRICS,PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. OWEN MARK ROSENBERG (PRACTICE ADVISOR)
(386) 325-9811
Entity
Organization
Contact information
Practice address
6910 OLD WOLF BAY RD, PALATKA, FL 32177-6800
(386) 328-7337
Mailing address
6910 OLD WOLF BAY RD, PALATKA, FL 32177-6800
(386) 328-7337
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
107889601
—
FL
01
—
72696
BLUE CROSS BLUE SHIELD FL
FL
Enumeration date
10/12/2005
Last updated
03/15/2021
Update your record
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