Provider Demographics
NPI:1558353854
Name:FAMILY PRACTICE ASSOCIATES OF JACKSONVILLE
Entity Type:Organization
Organization Name:FAMILY PRACTICE ASSOCIATES OF JACKSONVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-739-1140
Mailing Address - Street 1:6111 BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-2751
Mailing Address - Country:US
Mailing Address - Phone:904-739-1140
Mailing Address - Fax:904-722-1674
Practice Address - Street 1:6111 BEACH BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-2751
Practice Address - Country:US
Practice Address - Phone:904-739-1140
Practice Address - Fax:904-722-1674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty