Organization
DRS BAKER & GILMOUR MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JODY BOSTIC (PRACTICE ADMINISTRATOR)
(904) 733-4444
Entity
Organization
Contact information
Practice address
300 HEALTH PARK BLVD, SUITE 1006, ST AUGUSTINE, FL 32086-3707
(904) 794-7050
Mailing address
3550 UNIVERSITY BLVD S, SUITE 302, JACKSONVILLE, FL 32216-4246
(904) 733-4444
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
207RI0011X
Interventional Cardiology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
252952100
—
FL
01
—
77241
BCBS
FL
01
—
CB1978
RAILROAD MEDICARE
FL
Enumeration date
01/12/2007
Last updated
12/11/2013
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