Organization
BEACHES BEHAVIORAL MEDICINE
Active
Other names
Beaches Specialty Group, Beaches Laser Spine and Pain Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JUSTIN KUHNS SPOONER MD (PRESIDENT)
(904) 280-6701
Entity
Organization
Contact information
Practice address
1351 13TH AVE S STE 120, JACKSONVILLE BEACH, FL 32250-3237
(904) 280-6701
(904) 280-6702
Mailing address
PO BOX 1557, PONTE VEDRA BEACH, FL 32004-1557
(904) 280-6701
(904) 280-6702
Taxonomy
Speciality
Code
Description
License number
State
207QA0401X
Addiction Medicine (Family Medicine) Physician
ME115625
FL
2083A0300X
Addiction Medicine (Preventive Medicine) Physician
—
—
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
—
—
2084P0800X
Psychiatry Physician
—
—
2084P0804X
Child & Adolescent Psychiatry Physician
—
—
2084P2900X
Pain Medicine (Psychiatry & Neurology) Physician
—
—
208VP0000X
Pain Medicine Physician
—
—
208VP0014X
Interventional Pain Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00863244100
—
FL
Enumeration date
07/09/2016
Last updated
01/12/2023
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