Provider Demographics
NPI:1326144700
Name:CAUDILL, JEFFREY D (MD)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:D
Last Name:CAUDILL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5851 TIMUQUANA RD
Mailing Address - Street 2:SUITE 401
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-7878
Mailing Address - Country:US
Mailing Address - Phone:904-317-5069
Mailing Address - Fax:
Practice Address - Street 1:5851 TIMUQUANA RD
Practice Address - Street 2:SUITE 401
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-7878
Practice Address - Country:US
Practice Address - Phone:904-317-5069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88799207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL275179800Medicaid
FL48119OtherBCBS
FL48119OtherBCBS
FL48119YMedicare PIN