Provider Demographics
NPI:1043279680
Name:INTERNAL MEDICINE OF JACKSONVILLE
Entity Type:Organization
Organization Name:INTERNAL MEDICINE OF JACKSONVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:ENRIQUE
Authorized Official - Last Name:RODOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-727-5151
Mailing Address - Street 1:1201 MONUMENT RD
Mailing Address - Street 2:STE 201
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225
Mailing Address - Country:US
Mailing Address - Phone:904-727-5151
Mailing Address - Fax:904-727-7714
Practice Address - Street 1:1201 MONUMENT RD
Practice Address - Street 2:STE 201
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-7411
Practice Address - Country:US
Practice Address - Phone:904-727-5151
Practice Address - Fax:904-727-7714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-22
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
K6454Medicare ID - Type Unspecified
D21353Medicare UPIN