Basic Information
| Provider Information | |||||||||
| NPI: | 1518126168 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNIVERSITY OF FLORIDA JACKSONVILLE PHYSICIANS, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | UFJP PRIMARY CARE NASSAU | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 44008 | ||||||||
| Address2: | UFJP PROVIDER ENROLLMENT | ||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322314008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042443660 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 851042 US HIGHWAY 17 | ||||||||
| Address2: | UFJP YULEE FAMILY PRACTICE | ||||||||
| City: | YULEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320972845 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9046330670 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2008 | ||||||||
| LastUpdateDate: | 06/07/2008 | ||||||||
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| AuthorizedOfficialLastName: | BENRUBI | ||||||||
| AuthorizedOfficialFirstName: | GUY | ||||||||
| AuthorizedOfficialMiddleName: | I. | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO/VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9042443109 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QA0000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | Adolescent Medicine | 207QA0505X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | Adult Medicine | 207QG0300X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | Geriatric Medicine | 207RG0300X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine | 208000000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | 207Q00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.