Clay Internal Medicine Pa | |
1406 Kingsley Ave Ste D Orange Park FL 32073-4528 | |
(904) 541-1780 | |
(904) 541-1785 |
Full Name | Clay Internal Medicine Pa |
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Speciality | Internal Medicine |
Location | 1406 Kingsley Ave Ste D, Orange Park, Florida |
Authorized Official Name and Position | Jeffrey Bruce Chesler (PRESIDENT) |
Authorized Official Contact | 9045411780 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Clay Internal Medicine Pa 1406 Kingsley Ave Suite D Orange Park FL 32073-4590 Ph: (904) 541-1780 | Clay Internal Medicine Pa 1406 Kingsley Ave Ste D Orange Park FL 32073-4528 Ph: (904) 541-1780 |
NPI Number | 1205973682 |
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Provider Enumeration Date | 02/01/2007 |
Last Update Date | 06/25/2012 |
Medicare PECOS PAC ID | 7113182148 |
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Medicare Enrollment ID | O20120626000075 |
Identifier | Type | State | Issuer |
---|---|---|---|
1205973682 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | ME0053362 (Florida) | Primary |
Provider Name | Jeffrey B Chesler |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1639258221 PECOS PAC ID: 2567627599 Enrollment ID: I20120626000104 |
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