Provider Demographics
NPI:1043436413
Name:MONA AND GONDER, P.A.
Entity Type:Organization
Organization Name:MONA AND GONDER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:GERMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-396-9096
Mailing Address - Street 1:3599 UNIVERSITY BLVD S STE 905
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-4295
Mailing Address - Country:US
Mailing Address - Phone:904-396-9096
Mailing Address - Fax:904-396-1691
Practice Address - Street 1:3599 UNIVERSITY BLVD S STE 905
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4295
Practice Address - Country:US
Practice Address - Phone:904-396-9096
Practice Address - Fax:904-396-1691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0027743174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD52568Medicare UPIN
FLD52983Medicare UPIN