Provider Demographics
NPI:1518101369
Name:NORTH FLORIDA PHYSICAL MEDICINE, INC.
Entity Type:Organization
Organization Name:NORTH FLORIDA PHYSICAL MEDICINE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PD
Authorized Official - Prefix:
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:
Authorized Official - Last Name:GARVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-262-9444
Mailing Address - Street 1:2020 KINGSLEY AVE SUITE D
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-8705
Mailing Address - Country:US
Mailing Address - Phone:904-458-1308
Mailing Address - Fax:904-458-1313
Practice Address - Street 1:2020 KINGSLEY AVE STE D
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-5139
Practice Address - Country:US
Practice Address - Phone:904-458-1308
Practice Address - Fax:904-458-1313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-23
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center