Organization
CARTE BLANCHE HOLDINGS, INC
Active
Other names
Medi Weightloss
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BLAKE A KOZOL (PRESIDENT)
(904) 625-0038
Entity
Organization
Contact information
Practice address
13546 BEACH BLVD, UNIT 2, JACKSONVILLE, FL 32224-7232
(904) 574-5000
Mailing address
1626 N LIBERTY ST, JACKSONVILLE, FL 32206-4649
(904) 625-0038
Taxonomy
Speciality
Code
Description
License number
State
207QB0002X
Obesity Medicine (Family Medicine) Physician
Primary
ME42368
FL
207RB0002X
Obesity Medicine (Internal Medicine) Physician
—
—
207VB0002X
Obesity Medicine (Obstetrics & Gynecology) Physician
—
—
Other
Enumeration date
09/15/2015
Last updated
09/15/2015
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