Provider Demographics
NPI:1598001257
Name:PARTIN, WAYNE (IDC)
Entity Type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:
Last Name:PARTIN
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2480 BON HOMMES RICHARD ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32227
Mailing Address - Country:US
Mailing Address - Phone:904-528-8216
Mailing Address - Fax:
Practice Address - Street 1:2480 BON HOMMES RICHARD ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32227
Practice Address - Country:US
Practice Address - Phone:904-528-8216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-27
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman