Provider Demographics
NPI:1912188624
Name:SOUTHERN INTERNAL MEDICINE PLLC
Entity Type:Organization
Organization Name:SOUTHERN INTERNAL MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:GUY
Authorized Official - Middle Name:S
Authorized Official - Last Name:STRAUSS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:904-521-5388
Mailing Address - Street 1:7896 BRIARWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:GLEN SAINT MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32040-4706
Mailing Address - Country:US
Mailing Address - Phone:904-521-5388
Mailing Address - Fax:904-259-7845
Practice Address - Street 1:404 NW HALL OF FAME DR
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055-4833
Practice Address - Country:US
Practice Address - Phone:386-754-2433
Practice Address - Fax:386-754-2586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-21
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS4706207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty