Organization
PHYSICIAN ASSOCIATES GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEREMY MIRABILE MD (MEDICAL DOCTOR)
(904) 342-5965
Entity
Organization
Contact information
Practice address
1301 PLANTATION ISLAND DR S, SUITE 201-A, ST AUGUSTINE, FL 32080-3108
(904) 342-5965
Mailing address
1301 PLANTATION ISLAND DR S, SUITE 201-A, ST AUGUSTINE, FL 32080-3108
(904) 342-5965
Taxonomy
Speciality
Code
Description
License number
State
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
Primary
ME88707
FL
Other
Enumeration date
03/02/2016
Last updated
03/02/2016
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