Provider Demographics
NPI:1003874363
Name:BILLINGSLEY, MAX T (MD)
Entity Type:Individual
Prefix:
First Name:MAX
Middle Name:T
Last Name:BILLINGSLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 863026
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32886-3026
Mailing Address - Country:US
Mailing Address - Phone:904-346-5426
Mailing Address - Fax:904-346-0113
Practice Address - Street 1:1 SHIRCLIFF WAY
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-4748
Practice Address - Country:US
Practice Address - Phone:904-346-5426
Practice Address - Fax:904-346-0113
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0045015207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL044556800Medicaid
FL930000750OtherRRMCR
FL14148OtherBCBS
FL14148OtherBCBS
FL14148ZMedicare ID - Type Unspecified