Basic Information
Provider Information
NPI: 1730159427
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: VOLK
FirstName: ALBERT
MiddleName: G
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: ONE ORTHOPAEDIC PLACE
Address2:  
City: ST AUGUSTINE
State: FL
PostalCode: 320864202
CountryCode: US
TelephoneNumber: 9048250540
FaxNumber: 9042091055
Practice Location
Address1: ONE ORTHOPAEDIC PLACE
Address2:  
City: ST AUGUSTINE
State: FL
PostalCode: 320864202
CountryCode: US
TelephoneNumber: 9048250540
FaxNumber: 9042091055
Other Information
ProviderEnumerationDate: 01/25/2006
LastUpdateDate: 02/27/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207XX0005XME0066326FLY Allopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
207X00000XME0066326FLN Allopathic & Osteopathic PhysiciansOrthopaedic Surgery 

ID Information
IDTypeStateIssuerDescription
117454000101FLDMERCOTHER
117454000101FLCIGNO GOVT SVCSOTHER


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