Individual
KERRY MARK BACHISTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4500 SAN PABLO RD S, JACKSONVILLE, FL 32224-1865
(904) 953-2000
Mailing address
4500 SAN PABLO RD S, JACKSONVILLE, FL 32224-1865
(904) 953-2000
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
60790
GA
207P00000X
Emergency Medicine Physician
Primary
ME101449
FL
207P00000X
Emergency Medicine Physician
TRN9208
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2813769-00
—
FL
01
—
41057
BCBS
FL
Enumeration date
01/11/2007
Last updated
11/17/2022
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