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Specialty details in registry · St Augustine, FL

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At a glance

665 State Road 207, St Augustine, FL 32084-5938

NPPES record updated Jun 19, 2008. Public records can lag behind changes at a practice.

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Insurance participation and appointment availability are not established by these public records.

Practice location

665 State Road 207 Suite 102
St Augustine, FL 32084-5938
Professional details: NPI, taxonomy & registry record
NPI1275584492
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Registry details

Primary taxonomy
Specialty details in registry
Taxonomy code
207RN0300X
Enumeration date
May 12, 2006
Record updated
Jun 19, 2008
More registry details
Provider type
Organization · Type 2
Other reported name
<UNAVAIL>

Reported taxonomies and licenses

Family Medicine

207Q00000X

Specialty details in registry

207RN0300X · Primary

Specialty details in registry

207RP1001X

License numbers and credentials are reported to NPPES; HCPList does not independently verify them.

Practice location

665 State Road 207
Suite 102
St Augustine, FL 32084-5938
Phone
(904) 824-8158
Fax
(904) 823-1284
Mailing address
665 STATE ROAD 207
SUITE 102
ST AUGUSTINE, FL 320845938
Source: NPPES Source through Oct 18, 2026An NPI does not verify licensure or credentials.

Information may be outdated or incomplete. Confirm details directly with the practice. HCPList is an independent directory and is not affiliated with CMS.

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