Provider Demographics
NPI:1811041015
Name:ALLERGY & ASTHMA SPECIALISTS OF NORTH FLORIDA PA
Entity Type:Organization
Organization Name:ALLERGY & ASTHMA SPECIALISTS OF NORTH FLORIDA PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:DEMARCO
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:904-272-5251
Mailing Address - Street 1:1895 KINGSLEY AVE
Mailing Address - Street 2:SUITE 401
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4466
Mailing Address - Country:US
Mailing Address - Phone:904-730-4870
Mailing Address - Fax:904-276-0459
Practice Address - Street 1:1895 KINGSLEY AVE
Practice Address - Street 2:SUITE 401
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4466
Practice Address - Country:US
Practice Address - Phone:904-272-5251
Practice Address - Fax:904-276-0459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME86337207K00000X
FLME25318207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1730172370OtherINDIVIDUAL NPI
FL1174717276OtherNPI
FL1578598967OtherINDIVIDUAL NPI