Provider Demographics
NPI:1386193597
Name:MEDICAL STUDIO INC
Entity Type:Organization
Organization Name:MEDICAL STUDIO INC
Other - Org Name:THE MEDICAL STUDIO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED REPRESENTATIVE
Authorized Official - Prefix:DR
Authorized Official - First Name:GABOR
Authorized Official - Middle Name:
Authorized Official - Last Name:MENCZELESZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-575-2285
Mailing Address - Street 1:4312 PLAZA GATE LN S
Mailing Address - Street 2:APT 101
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-5411
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1437 FLAGLER AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8516
Practice Address - Country:US
Practice Address - Phone:904-575-2285
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-28
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME122201261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME122201OtherLICENSE
FLME122201OtherLICENSE