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100 Whetstone Pl Suite 105 St Augustine FL 32086-5773 | |
| (904) 829-9557 | |
| (904) 829-9125 |
| Full Name | |
|---|---|
| Speciality | Internal Medicine - Gastroenterology |
| Location | 100 Whetstone Pl, St Augustine, Florida |
| Authorized Official Name and Position | Benoit C Pineau (AUTHORIZED OFFICIAL) |
| Authorized Official Contact | 9048299557 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
100 Whetstone Pl Suite 105 St Augustine FL 32086-5773 Ph: (904) 829-9557 | 100 Whetstone Pl Suite 105 St Augustine FL 32086-5773 Ph: (904) 829-9557 |
| NPI Number | 1528068624 |
|---|---|
| Provider Enumeration Date | 07/29/2005 |
| Last Update Date | 10/09/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528068624 | NPI | - | NPPES |
| P00147263 | Other | MEDICARE RR | |
| DC0902 | Other | MEDICARE RR - GROUP # | |
| 44069 | Other | FL | BCBS |
| 269931100 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | ME90376 (Florida) | Primary |
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