Basic Information
Provider Information
NPI: 1194959916
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FONT
FirstName: RUBEN
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 655 W. EIGHTH ST. BOX C506
Address2: CLINICAL CENTER, 1ST FLOOR
City: JACKSONVILLE
State: FL
PostalCode: 32209
CountryCode: US
TelephoneNumber: 9042443837
FaxNumber: 9042444508
Practice Location
Address1: 655 W. EIGHTH ST. BOX C506
Address2: CLINICAL CENTER, 1ST FLOOR
City: JACKSONVILLE
State: FL
PostalCode: 32209
CountryCode: US
TelephoneNumber: 9042443837
FaxNumber: 9042444508
Other Information
ProviderEnumerationDate: 05/07/2009
LastUpdateDate: 05/07/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207P00000XTRN13491FLY Allopathic & Osteopathic PhysiciansEmergency Medicine 

No ID Information.


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