Organization
LIGHTHOUSE ANESTHESIOLOGY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN DOYLE M.D. (OWNER)
(904) 824-4990
Entity
Organization
Contact information
Practice address
400 HEALTH PARK BLVD, ST AUGUSTINE, FL 32086-5784
(904) 819-5155
Mailing address
PO BOX 3012, ST AUGUSTINE, FL 32085-3012
(904) 824-4990
(904) 824-2226
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
34970
BLUE CROSS BLUE SHIELD
FL
Enumeration date
07/10/2006
Last updated
08/22/2020
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