Organization
FLAGLER FAMILY MEDICINE P A
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. RUTH J FAIRCLOTH (ACCOUNTS RECEVIABLE MANAGER)
(904) 826-3469
Entity
Organization
Contact information
Practice address
130 HEALTH PARK BLVD, ST AUGUSTINE, FL 32086-5776
(904) 826-3469
(904) 808-4608
Mailing address
130 HEALTH PARK BLVD, ST AUGUSTINE, FL 32086-5776
(904) 826-3469
(904) 808-4608
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
252488100
—
FL
01
—
CD6611
PALMETTO GBA RAILROAD MED
FL
Enumeration date
01/19/2007
Last updated
07/23/2008
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