Organization
ATLANTIC UROLOGICAL ASSOCIATES P A
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JERRI CREGGAR (CHIEF OPERATING OFFICER)
(386) 239-8500
Entity
Organization
Contact information
Practice address
545 HEALTH BLVD, DAYTONA BEACH, FL 32114-1493
(386) 239-8500
(386) 239-8530
Mailing address
545 HEALTH BLVD, DAYTONA BEACH, FL 32114-1493
(386) 239-8500
(386) 239-8530
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
037142400
—
FL
01
—
1900147
UNITED HEALTHCARE
—
01
—
99107
BLUE SHIELD
FL
Enumeration date
04/24/2006
Last updated
12/13/2012
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