Provider Demographics
NPI:1760438121
Name:NATURAL MEDICINE AND WELLNESS CENTER OF JACKSONVILLE, INC.
Entity Type:Organization
Organization Name:NATURAL MEDICINE AND WELLNESS CENTER OF JACKSONVILLE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALFONSO
Authorized Official - Middle Name:M
Authorized Official - Last Name:BREMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-296-1116
Mailing Address - Street 1:4237 SALISBURY ROAD NORTH
Mailing Address - Street 2:SUITE 110
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216
Mailing Address - Country:US
Mailing Address - Phone:904-296-1116
Mailing Address - Fax:904-296-1467
Practice Address - Street 1:4237 SALISBURY ROAD NORTH
Practice Address - Street 2:SUITE 110
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216
Practice Address - Country:US
Practice Address - Phone:904-296-1116
Practice Address - Fax:904-296-1467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC69152083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental MedicineGroup - Multi-Specialty