Provider Demographics
NPI:1558746644
Name:NORTH FLORIDA FACIAL PLASTIC SURGERY LLC
Entity Type:Organization
Organization Name:NORTH FLORIDA FACIAL PLASTIC SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:F
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-247-8522
Mailing Address - Street 1:3500 VIA DE LA REINA
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-3673
Mailing Address - Country:US
Mailing Address - Phone:904-247-8522
Mailing Address - Fax:904-247-9722
Practice Address - Street 1:7807 BAYMEADOWS RD E
Practice Address - Street 2:SUITE 303
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-9664
Practice Address - Country:US
Practice Address - Phone:904-247-8522
Practice Address - Fax:904-247-9722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-30
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME776322082S0099X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and NeckGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
51049XOtherMEDICARE PTAN