Basic Information
| Provider Information | |||||||||
| NPI: | 1619939022 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PACK | ||||||||
| FirstName: | NORMAN | ||||||||
| MiddleName: | W. | ||||||||
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| Credential: | M.D. | ||||||||
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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: | 14546 SAINT AUGUSTINE RD | ||||||||
| Address2: | SUITE 311 | ||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322585468 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042602255 | ||||||||
| FaxNumber: | 9042602251 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | ME38773 | FL | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.