Provider Demographics
NPI:1184610420
Name:NORTH FLORIDA OTOLARYNGOLOGY ASSOCIATES PA
Entity type:Organization
Organization Name:NORTH FLORIDA OTOLARYNGOLOGY ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:P
Authorized Official - Last Name:LAUCKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-389-6570
Mailing Address - Street 1:1801 BARRS ST
Mailing Address - Street 2:SUITE 700
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-4732
Mailing Address - Country:US
Mailing Address - Phone:904-387-3001
Mailing Address - Fax:904-389-6627
Practice Address - Street 1:1801 BARRS ST
Practice Address - Street 2:SUITE 700
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-4732
Practice Address - Country:US
Practice Address - Phone:904-387-3001
Practice Address - Fax:904-389-6627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL00314OtherBS GRP NUMBER
FL00314Medicare ID - Type UnspecifiedMCR GRP #