Organization
COMMUNITY CARE PEDIATRICS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LUIS ANDERSON MD (MD/PRESIDENT/OWNER)
(904) 479-9501
Entity
Organization
Contact information
Practice address
3670 US 1 SOUTH STE 300 B, SAINT AUGUSTINE, FL 32086
(904) 479-9501
(904) 217-0524
Mailing address
3670 US 1 SOUTH STE 300 B, SAINT AUGUSTINE, FL 32086
(904) 479-9501
(904) 217-0524
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
—
—
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
269304600
—
FL
Enumeration date
04/28/2012
Last updated
02/14/2020
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