Organization
PHYSIATRY CONSULTS OF JACKSONVILLE. LLC
Active
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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