Provider Demographics
NPI:1265840771
Name:LONDON OBSTETRIC AND GYNECOLOGIC SERVICES, PA
Entity Type:Organization
Organization Name:LONDON OBSTETRIC AND GYNECOLOGIC SERVICES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:MINOLTA
Authorized Official - Last Name:LONDON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-880-1400
Mailing Address - Street 1:4114 SUNBEAM RD
Mailing Address - Street 2:BUILDING 100, SUITE 102
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-8847
Mailing Address - Country:US
Mailing Address - Phone:904-880-1400
Mailing Address - Fax:904-886-4433
Practice Address - Street 1:4114 SUNBEAM RD
Practice Address - Street 2:BUILDING 100, SUITE 102
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-8847
Practice Address - Country:US
Practice Address - Phone:904-880-1400
Practice Address - Fax:904-886-4433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-28
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0073682207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty