Provider Demographics
NPI:1467493288
Name:CHILDERS, DAVID OMER JR (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:OMER
Last Name:CHILDERS
Suffix:JR
Gender:M
Credentials:MD
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 44008
Mailing Address - Street 2:UFJP PROVIDER ENROLLMENT
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4008
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6271 SAINT AUGUSTINE RD
Practice Address - Street 2:UFJP DEVELOPMENTAL PEDIATRICS
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-2523
Practice Address - Country:US
Practice Address - Phone:904-633-0770
Practice Address - Fax:904-633-0751
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME86363208000000X, 2080P0008X, 2080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0008XAllopathic & Osteopathic PhysiciansPediatricsNeurodevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2658267-00Medicaid
GA000975301AMedicaid
GA000975301AMedicaid
FL2658267-00Medicaid
FL370022438Medicare PIN