Provider Demographics
NPI:1851325781
Name:N.F.L. CENTER FOR OTO-HNS FACIAL PLASTIC SURGERY P.A.
Entity Type:Organization
Organization Name:N.F.L. CENTER FOR OTO-HNS FACIAL PLASTIC SURGERY P.A.
Other - Org Name:NORTH FLORIDA CENTER FOR OTOLARYNGOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:CORT
Authorized Official - Last Name:TALIAFERRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-823-8823
Mailing Address - Street 1:3 SAN BARTOLA DR
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-5767
Mailing Address - Country:US
Mailing Address - Phone:904-823-8823
Mailing Address - Fax:904-808-1505
Practice Address - Street 1:3 SAN BARTOLA DR
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5767
Practice Address - Country:US
Practice Address - Phone:904-823-8823
Practice Address - Fax:904-808-1505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Multi-Specialty
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
No207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & NeurotologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL274492900Medicaid
FL274492902Medicaid
FL274492901Medicaid
FLDD8481OtherRAILROAD MEDICARE
FL274492900Medicaid