Basic Information
| Provider Information | |||||||||
| NPI: | 1316907926 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTH FLORIDA OBSTETRICAL AND GYNECOLOGICAL ASSOCIATES PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 16568 | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322456568 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9044722300 | ||||||||
| FaxNumber: | 9044722330 | ||||||||
| Practice Location | |||||||||
| Address1: | 11437 CENTRAL PKWY | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322242706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9044722300 | ||||||||
| FaxNumber: | 9044722330 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2006 | ||||||||
| LastUpdateDate: | 04/06/2018 | ||||||||
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| AuthorizedOfficialLastName: | GREENE | ||||||||
| AuthorizedOfficialFirstName: | C. | ||||||||
| AuthorizedOfficialMiddleName: | CAMERON | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9044722300 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 370581101 | 05 | FL | MEDICAID | 370581118 | 05 | FL | MEDICAID | 370581119 | 05 | FL | MEDICAID | 370581129 | 05 | FL | MEDICAID | 370581108 | 05 | FL | MEDICAID | 370581112 | 05 | FL | MEDICAID | 370581102 | 05 | FL | MEDICAID | 370581116 | 05 | FL | MEDICAID | 370581100 | 05 | FL | MEDICAID | 370581104 | 05 | FL | MEDICAID | 370581110 | 05 | FL | MEDICAID | 370581123 | 05 | FL | MEDICAID | 370581103 | 05 | FL | MEDICAID | 370581106 | 05 | FL | MEDICAID | 370581126 | 05 | FL | MEDICAID | 370581105 | 05 | FL | MEDICAID | 370581117 | 05 | FL | MEDICAID | 370581120 | 05 | FL | MEDICAID | 370581121 | 05 | FL | MEDICAID | 370581109 | 05 | FL | MEDICAID | 370581113 | 05 | FL | MEDICAID | 370581114 | 05 | FL | MEDICAID | 370581125 | 05 | FL | MEDICAID | 370581107 | 05 | FL | MEDICAID | 370581115 | 05 | FL | MEDICAID | 370581128 | 05 | FL | MEDICAID |