Individual
DR. JEREMY ALAN CAUDILL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
2460 OLD MOULTRIE RD STE 3, SAINT AUGUSTINE, FL 32086-4198
(904) 797-6627
(386) 328-4125
Mailing address
2460 OLD MOULTRIE RD STE 3, SAINT AUGUSTINE, FL 32086-4198
(904) 797-6627
(904) 797-6028
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
OS10861
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002389800
—
FL
05
—
003413200
—
FL
Enumeration date
04/23/2007
Last updated
07/16/2019
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