Provider Demographics
NPI:1962468892
Name:COLEY, PAUL ANDREW JR (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ANDREW
Last Name:COLEY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:P.
Other - Middle Name:ANDREW
Other - Last Name:COLEY
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:8773 PERIMETER PARK CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-1165
Mailing Address - Country:US
Mailing Address - Phone:904-493-3390
Mailing Address - Fax:904-493-3395
Practice Address - Street 1:3627 UNIVERSITY BLVD S STE 300
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216
Practice Address - Country:US
Practice Address - Phone:904-396-0300
Practice Address - Fax:904-396-3039
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME24172207RC0200X, 207RI0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL40079OtherAVMED
FLGR172AOtherMEDICARE - GROUP
FL0098365-00OtherFL MEDICAID - GROUP
FL407111035OtherRR MEDICARE
FL15339OtherFL BLUE
FL052627400Medicaid
FL15339YOtherMEDICARE - INDIVIDUAL
FL146184OtherWELLCARE
FL15339YOtherMEDICARE - INDIVIDUAL