Organization
FM MEDICAL CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SCOTT R MICHAELS MD (CLINIC DIRECTOR)
(904) 823-8833
Entity
Organization
Contact information
Practice address
165 SOUTHPARK BLVD, ST AUGUSTINE, FL 32086-4101
(904) 823-8833
(904) 823-9394
Mailing address
165 SOUTHPARK BLVD, ST AUGUSTINE, FL 32086-4101
(904) 823-8833
(904) 823-9394
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
M242796603210
DRIVERS LICENSES
FL
Enumeration date
03/16/2018
Last updated
03/17/2018
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