Organization
JACKSONVILLE INTERNAL MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. REY GAVINO (OWNER)
(256) 435-5499
Entity
Organization
Contact information
Practice address
2270 PELHAM RD S, JACKSONVILLE, AL 36265-9582
(256) 435-5499
(256) 435-6064
Mailing address
PO BOX 550, JACKSONVILLE, AL 36265
(256) 435-5499
(256) 435-6064
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
25404
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01D1017203
CLIA
AL
05
—
529917260
—
AL
Enumeration date
11/08/2006
Last updated
01/11/2012
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