Provider Demographics
NPI:1275867335
Name:NORTH FLORIDA PULMONARY ASSOCIATES, LLC
Entity Type:Organization
Organization Name:NORTH FLORIDA PULMONARY ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGRM
Authorized Official - Prefix:
Authorized Official - First Name:BASSEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMADAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-371-2756
Mailing Address - Street 1:11512 LAKE MEAD AVE
Mailing Address - Street 2:UNIT # 303
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-9680
Mailing Address - Country:US
Mailing Address - Phone:904-371-2756
Mailing Address - Fax:904-900-3590
Practice Address - Street 1:11512 LAKE MEAD AVE
Practice Address - Street 2:UNIT # 303
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-9680
Practice Address - Country:US
Practice Address - Phone:904-371-2756
Practice Address - Fax:904-900-3590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-22
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME87777174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCN387AOtherMEDICARE