Provider Demographics
NPI:1417559147
Name:FAMILY CARE PARTNERS OF NORTHEAST FLORIDA LLC
Entity Type:Organization
Organization Name:FAMILY CARE PARTNERS OF NORTHEAST FLORIDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:
Authorized Official - Last Name:MALTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:833-309-3737
Mailing Address - Street 1:6900 TAVISTOCK LAKES BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32827-7592
Mailing Address - Country:US
Mailing Address - Phone:904-745-3618
Mailing Address - Fax:904-722-4271
Practice Address - Street 1:1215 DUNN AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-6330
Practice Address - Country:US
Practice Address - Phone:904-757-1998
Practice Address - Fax:904-696-7462
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY CARE PARTNERS OF NORTHEAST FLORIDA, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-11-09
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty