Basic Information
Provider Information
NPI: 1366423675
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ARROWOOD
FirstName: MICHAEL
MiddleName: EDWARD
NamePrefix: MR.
NameSuffix:  
Credential: PA-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4500 SAN PABLO RD S
Address2:  
City: JACKSONVILLE
State: FL
PostalCode: 322241865
CountryCode: US
TelephoneNumber: 9049532000
FaxNumber:  
Practice Location
Address1: 4500 SAN PABLO RD S
Address2:  
City: JACKSONVILLE
State: FL
PostalCode: 322241865
CountryCode: US
TelephoneNumber: 9049532000
FaxNumber:  
Other Information
ProviderEnumerationDate: 11/14/2005
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: X
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363AM0700XPA9103567FLY Physician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical

No ID Information.


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