Individual
DR. FREDERICK SHERWIN VINES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
655 W 8TH ST, UFJP RADIOLOGY DEPT, JACKSONVILLE, FL 32209-6511
(904) 244-4782
(904) 244-3382
Mailing address
PO BOX 44008, UFJP PROVIDER ENROLLMENT, JACKSONVILLE, FL 32231-4008
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
ME43844
FL
2085N0700X
Neuroradiology Physician
ME43844
FL
2085R0202X
Diagnostic Radiology Physician
Primary
ME43844
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000291761A
—
GA
05
—
0690481-00
—
FL
01
—
300024357
RAILROAD MEDICARE
FL
Enumeration date
02/16/2006
Last updated
01/14/2010
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