Basic Information
| Provider Information | |||||||||
| NPI: | 1871611749 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ST AUGUSTINE NEUROLOGY PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 301 HEALTH PARK BLVD | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | ST AUGUSTINE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320865793 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9048242201 | ||||||||
| FaxNumber: | 9048242373 | ||||||||
| Practice Location | |||||||||
| Address1: | 301 HEALTH PARK BLVD | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | ST AUGUSTINE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320865793 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9048242201 | ||||||||
| FaxNumber: | 9048242373 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2007 | ||||||||
| LastUpdateDate: | 09/30/2011 | ||||||||
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| AuthorizedOfficialLastName: | WEI | ||||||||
| AuthorizedOfficialFirstName: | JUEYANG | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT AND CEO | ||||||||
| AuthorizedOfficialTelephone: | 9048242201 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM2500X | ME97839 | FL | Y | Ambulatory Health Care Facilities | Clinic/Center | Medical Specialty |
ID Information
| ID | Type | State | Issuer | Description | 1346249455 | 01 | NPI FOR JUEYANG WEI, MD | OTHER |