Organization
JEREMY CAUDILL DO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEREMY ALAN CAUDILL D.O., (PRESIDENT)
(904) 797-6627
Entity
Organization
Contact information
Practice address
2460 OLD MOULTRIE RD STE 3, ST AUGUSTINE, FL 32086-4198
(904) 797-6627
(888) 640-9997
Mailing address
2460 OLD MOULTRIE RD STE 3, ST AUGUSTINE, FL 32086-4198
(904) 797-6627
(888) 640-9997
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
OS10861
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OS10861
MEDICAL LICENSE
FL
Enumeration date
04/21/2017
Last updated
06/01/2017
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