1578514386 NPI number — INTERNAL MEDICINE ASSOCIATES OF NORTHEAST FLORIDA PA

Table of content: DEVI MORRISON WALTERS MD (NPI 1659891083)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578514386 NPI number — INTERNAL MEDICINE ASSOCIATES OF NORTHEAST FLORIDA PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTERNAL MEDICINE ASSOCIATES OF NORTHEAST FLORIDA PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578514386
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1555 KINGSLEY AVE
Provider Second Line Business Mailing Address:
SUITE 604
Provider Business Mailing Address City Name:
ORANGE PARK
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32073-4560
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-541-0670
Provider Business Mailing Address Fax Number:
904-541-0680

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1555 KINGSLEY AVE
Provider Second Line Business Practice Location Address:
SUITE 604
Provider Business Practice Location Address City Name:
ORANGE PARK
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32073-4560
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-541-0670
Provider Business Practice Location Address Fax Number:
904-541-0680
Provider Enumeration Date:
05/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCLEAN
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
LYN
Authorized Official Title or Position:
BUSINESS MANAGER
Authorized Official Telephone Number:
904-541-0702

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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