Provider Demographics
NPI:1346202488
Name:WOMENS HEALTH CARE OF ST AUGUSTINE PA
Entity Type:Organization
Organization Name:WOMENS HEALTH CARE OF ST AUGUSTINE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:DUPREE JR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-797-4440
Mailing Address - Street 1:101 WHITEHALL DR
Mailing Address - Street 2:STE 108
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-5268
Mailing Address - Country:US
Mailing Address - Phone:904-797-4440
Mailing Address - Fax:904-797-4997
Practice Address - Street 1:101 WHITEHALL DR
Practice Address - Street 2:STE 108
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5268
Practice Address - Country:US
Practice Address - Phone:904-797-4440
Practice Address - Fax:904-797-4997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-04
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFLME0055260174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL063244900Medicaid
FL72776Medicare PIN
FL063244900Medicaid