Provider Demographics
NPI:1467722025
Name:FIRST COAST ENDOCRINOLOGY, P.A.
Entity Type:Organization
Organization Name:FIRST COAST ENDOCRINOLOGY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:OESTERLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-810-2425
Mailing Address - Street 1:300 HEALTH PARK BLVD
Mailing Address - Street 2:SUITE 3008
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-3707
Mailing Address - Country:US
Mailing Address - Phone:904-810-2425
Mailing Address - Fax:904-810-5321
Practice Address - Street 1:300 HEALTH PARK BLVD
Practice Address - Street 2:SUITE 3008
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-3707
Practice Address - Country:US
Practice Address - Phone:904-810-2425
Practice Address - Fax:904-810-5321
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FIRST COAST ENDOCRINOLOGY, P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-01-12
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0067870207R00000X
FLME0067670207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG38265Medicare UPIN
FLFY094AMedicare PIN