Organization
LAKESHORE MEDICAL CARE CENTER, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS TRACY TEAGLE (OFFICE MANAGER)
(904) 384-5385
Entity
Organization
Contact information
Practice address
4616 SAN JUAN AVE, JACKSONVILLE, FL 32210-3228
(904) 384-5385
(904) 388-5838
Mailing address
4616 SAN JUAN AVE, JACKSONVILLE, FL 32210-3228
(904) 384-5385
(904) 388-5838
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
0042816
FL
305R00000X
Preferred Provider Organization
ME0018387
FL
Other
Enumeration date
11/29/2006
Last updated
12/27/2010
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