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Organization

PHYSIATRY CONSULTS OF JACKSONVILLE. LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. NATALYA BULAEVA BULAEVA MD (MGR)
(904) 860-1123
Entity
Organization

Contact information

Practice address
1750 STOCKTON ST, JACKSONVILLE, FL 32204-4664
(190) 486-0112
Mailing address
836 BAYTREE LN, PONTE VEDRA BEACH, FL 32082-4162
(904) 860-1123

Taxonomy

Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
003169167A
GA
Enumeration date
08/01/2018
Last updated
08/01/2018
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