Provider Demographics
NPI:1003951138
Name:LIVE OAK MEDICAL ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:LIVE OAK MEDICAL ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:R
Authorized Official - Last Name:HALFON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-932-2203
Mailing Address - Street 1:2896 GULF BREEZE PKWY
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32563-3146
Mailing Address - Country:US
Mailing Address - Phone:850-932-2203
Mailing Address - Fax:850-934-0050
Practice Address - Street 1:2896 GULF BREEZE PKWY
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32563-3146
Practice Address - Country:US
Practice Address - Phone:850-932-2203
Practice Address - Fax:850-934-0050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCD1897OtherRAILROAD MEDICARE
FLCD1897OtherRAILROAD MEDICARE
FLCD1897OtherRAILROAD MEDICARE