Organization
FIRST COAST MEDICAL ASSOCIATES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAVI K KANCHA MD (DOCTO)
(904) 400-6800
Entity
Organization
Contact information
Practice address
13241 BARTRAM PARK BLVD UNIT 413, JACKSONVILLE, FL 32258-5237
(904) 400-6800
(904) 400-6801
Mailing address
13241 BARTRAM PARK BLVD UNIT 413, JACKSONVILLE, FL 32258-5237
(904) 400-6800
(904) 400-6801
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
305R00000X
Preferred Provider Organization
ME98044
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
277639100
—
FL
Enumeration date
08/21/2014
Last updated
11/12/2014
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