Provider Demographics
NPI:1437495868
Name:FLORIDA PHYSICIAN SPECIALISTS LLC
Entity Type:Organization
Organization Name:FLORIDA PHYSICIAN SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:D
Authorized Official - Last Name:TERK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-309-8680
Mailing Address - Street 1:836 PRUDENTIAL DRIVE
Mailing Address - Street 2:SUITE 1606
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-8343
Mailing Address - Country:US
Mailing Address - Phone:904-396-3700
Mailing Address - Fax:904-398-3871
Practice Address - Street 1:836 PRUDENTIAL DRIVE
Practice Address - Street 2:SUITE 1606
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8343
Practice Address - Country:US
Practice Address - Phone:904-396-3700
Practice Address - Fax:904-398-3871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-12
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME38972208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty