Provider Demographics
NPI:1245477991
Name:UNIVERSITY OF FLORIDA COLLEGE OF MEDICINE
Entity type:Organization
Organization Name:UNIVERSITY OF FLORIDA COLLEGE OF MEDICINE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DEPARTMENT HEAD, CHILD PROTECTION T
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCINTOSH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-633-0300
Mailing Address - Street 1:4539 BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-4738
Mailing Address - Country:US
Mailing Address - Phone:904-633-0300
Mailing Address - Fax:
Practice Address - Street 1:4539 BEACH BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-4738
Practice Address - Country:US
Practice Address - Phone:904-633-0300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-17
Last Update Date:2009-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1152452261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty