Active NPI 1780674606 Individual Practitioner Male Practitioner

Dr. James Waldorf , MD

Plastic Surgery • Jacksonville, FL

Professional Overview & Biography Verified Profile Summary

Dr. James Waldorf, MD is a registered healthcare professional specializing in Plastic Surgery in Jacksonville, FL. Practice services are available at 4500 SAN PABLO RD S under active NPI credentials.

Frequently performed procedures and clinical services include established patient outpatient office visit, new patient outpatient office visit, removal of growth (0.6 to 1.0 centimeters) of the face, ears, eyelids, nose, lips, or mouth. Full Medicare procedure pricing transparency rates and service volume details are listed on this profile.

Practice Location & Contact Primary Location

Practice Address

4500 San Pablo Rd S

Jacksonville, FL 322241865

Telephone 9049532000

Associated Practice Facility / Clinic

🏢 Mayo Clinic Jacksonville Facility NPI 1790772317

Specialty Benchmarks & Practice Insights

Comparative analytics for Plastic Surgery in Jacksonville, FL

Active Practitioner

Practitioner Clinical Experience

Active

City Avg: 23.3 Yrs

State Avg: 29.6 Yrs

Regional Practice Density

21 Specialists

Practicing in Jacksonville, FL (537 Statewide)

Telehealth Adoption Rate

19.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount

74.5% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2023)

Reporting Year:

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	86	63	$182.00	$55.68
99213 Established patient office or other outpatient visit, typically 15 minutes	70	67	$296.00	$89.87
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	26	26	$456.00	$112.48
11441 Removal of growth (0.6 to 1.0 centimeters) of the face, ears, eyelids, nose, lips, or mouth	24	22	$521.71	$128.48
11401 Removal of noncancer skin growth of body, arms, or legs, 0.6-1.0 cm	24	20	$403.92	$110.32
99202 New patient office or other outpatient visit, typically 20 minutes	19	19	$304.00	$71.88
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	18	11	$33.30	$1.08
11402 Removal of noncancer skin growth of body, arms, or legs, 1.1-2.0 cm	13	13	$456.73	$124.92
11641 Removal of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 0.6-1.0 cm	12	11	$799.75	$196.92
12051 Intermediate repair of wound of face, ears, eyelids, nose, lips, or mouth, 2.5 cm or less	12	12	$998.58	$235.45
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	11	11	$1000.00	$252.74
11440 Removal of noncancer skin growth of face, ears, eyelids, nose, lips, or mouth, 0.5 cm or less	11	11	$341.82	$96.53

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99213 Established patient office or other outpatient visit, typically 15 minutes	215	169	$296.00	$90.51
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	84	65	$182.00	$56.15
11401 Removal of noncancer skin growth of body, arms, or legs, 0.6-1.0 cm	52	40	$418.19	$116.24
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	44	44	$456.00	$112.93
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	38	15	$26.51	$1.11
11402 Removal of noncancer skin growth of body, arms, or legs, 1.1-2.0 cm	35	31	$473.21	$120.13
29580 Strapping, unna boot	33	14	$170.74	$57.28
11441 Removal of growth (0.6 to 1.0 centimeters) of the face, ears, eyelids, nose, lips, or mouth	32	29	$556.03	$139.90
99202 New patient office or other outpatient visit, typically 20 minutes	32	32	$304.00	$71.69
11440 Removal of noncancer skin growth of face, ears, eyelids, nose, lips, or mouth, 0.5 cm or less	27	27	$382.96	$113.96
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	26	22	$789.06	$206.83
11601 Removal of malignant growth (0.6 to 1.0 centimeters) of the trunk, arms, or legs	23	19	$657.57	$174.36
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	21	21	$450.00	$127.39
17000 Destruction of skin growth	20	19	$304.00	$45.26
11421 Removal of noncancer skin growth of scalp, neck, hands, feet, or genitals, 0.6-1.0 cm	19	15	$422.79	$105.82
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	19	14	$643.32	$135.63
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	19	18	$1013.16	$263.24
12051 Intermediate repair of wound of face, ears, eyelids, nose, lips, or mouth, 2.5 cm or less	19	18	$1042.00	$277.95
11641 Removal of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 0.6-1.0 cm	18	16	$761.67	$191.32
11301 Shaving of skin growth of body, arms, or legs, 0.6-1.0 cm	16	13	$282.47	$72.58
11442 Removal of noncancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	15	14	$542.13	$123.28
11900 Injection into skin growth, 1-7 growths	14	11	$200.79	$46.30
11642 Removal of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	12	11	$893.00	$179.13
11403 Removal of noncancer skin growth of body, arms, or legs, 2.1-3.0 cm	11	11	$515.45	$118.25

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99213 Established patient office or other outpatient visit, typically 15 minutes	216	182	$94.16	$91.57
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	126	102	$56.76	$56.14
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	39	15	$24.92	$1.29
99202 New patient office or other outpatient visit, typically 20 minutes	37	37	$73.00	$73.56
11441 Removal of growth (0.6 to 1.0 centimeters) of the face, ears, eyelids, nose, lips, or mouth	34	31	$189.14	$114.04
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	27	27	$112.81	$113.67
11401 Removal of noncancer skin growth of body, arms, or legs, 0.6-1.0 cm	27	23	$156.37	$119.59
29580 Strapping, unna boot	25	11	$68.58	$58.85
11402 Removal of noncancer skin growth of body, arms, or legs, 1.1-2.0 cm	25	24	$173.15	$115.14
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	24	21	$129.70	$130.65
17000 Destruction of skin growth	24	23	$65.40	$42.56
12051 Intermediate repair of wound of face, ears, eyelids, nose, lips, or mouth, 2.5 cm or less	21	21	$284.05	$272.29
11440 Removal of noncancer skin growth of face, ears, eyelids, nose, lips, or mouth, 0.5 cm or less	21	21	$143.06	$102.95
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	20	18	$306.71	$278.17
11403 Removal of noncancer skin growth of body, arms, or legs, 2.1-3.0 cm	16	16	$200.09	$107.15
11900 Injection into skin growth, 1-7 growths	16	11	$56.03	$47.57
11442 Removal of noncancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	16	16	$194.51	$128.60
17281 Destruction of malignant growth (0.6 to 1.0 centimeters) of face, ears, eyelids, nose, lips, or mouth	15	15	$178.88	$126.21
11641 Removal of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 0.6-1.0 cm	15	13	$240.11	$185.45
11601 Removal of malignant growth (0.6 to 1.0 centimeters) of the trunk, arms, or legs	14	11	$231.86	$208.38
17261 Destruction of cancer skin growth of trunk, arms, or legs, 0.6-1.0 cm	14	13	$147.37	$100.81
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	12	12	$177.42	$163.74
12031 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.5 cm or less	11	11	$263.82	$253.58

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99213 Established patient office or other outpatient visit, typically 15 minutes	313	223	$78.57	$75.16
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	174	145	$46.19	$45.57
99202 New patient office or other outpatient visit, typically 20 minutes	36	36	$76.33	$76.88
11401 Removal of noncancer skin growth of body, arms, or legs, 0.6-1.0 cm	33	28	$153.44	$107.91
12051 Intermediate repair of wound of face, ears, eyelids, nose, lips, or mouth, 2.5 cm or less	29	28	$273.00	$265.39
11441 Removal of growth (0.6 to 1.0 centimeters) of the face, ears, eyelids, nose, lips, or mouth	29	27	$172.67	$132.26
17000 Destruction of skin growth	27	27	$74.75	$44.55
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	27	26	$109.15	$110.17
11442 Removal of noncancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	25	25	$192.73	$128.09
11402 Removal of noncancer skin growth of body, arms, or legs, 1.1-2.0 cm	21	20	$170.81	$110.65
11421 Removal of noncancer skin growth of scalp, neck, hands, feet, or genitals, 0.6-1.0 cm	20	18	$160.79	$109.77
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	20	20	$302.57	$244.27
11400 Removal of growth (0.5 centimeters or less) of the trunk, arms or legs	19	17	$125.42	$86.32
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	19	16	$176.57	$126.02
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	18	18	$108.33	$109.25
11642 Removal of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	17	15	$288.30	$170.11
17281 Destruction of malignant growth (0.6 to 1.0 centimeters) of face, ears, eyelids, nose, lips, or mouth	17	15	$178.80	$132.14
11301 Shaving of skin growth of body, arms, or legs, 0.6-1.0 cm	15	14	$121.00	$93.81
11440 Removal of noncancer skin growth of face, ears, eyelids, nose, lips, or mouth, 0.5 cm or less	15	15	$139.37	$103.26
17261 Destruction of cancer skin growth of trunk, arms, or legs, 0.6-1.0 cm	15	13	$145.17	$126.95
99201 New patient office or other outpatient visit, typically 10 minutes	15	15	$45.79	$46.22
12031 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.5 cm or less	12	12	$252.91	$222.97

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99213 Established patient office or other outpatient visit, typically 15 minutes	384	262	$83.93	$69.73
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	273	190	$52.38	$42.17
99202 New patient office or other outpatient visit, typically 20 minutes	98	98	$90.53	$71.90
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	55	55	$125.00	$101.63
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	49	44	$125.54	$102.02
17000 Destruction of skin growth	39	36	$81.28	$41.75
11401 Removal of noncancer skin growth of body, arms, or legs, 0.6-1.0 cm	38	34	$166.62	$102.03
11402 Removal of noncancer skin growth of body, arms, or legs, 1.1-2.0 cm	28	25	$189.87	$109.25
12051 Intermediate repair of wound of face, ears, eyelids, nose, lips, or mouth, 2.5 cm or less	26	25	$346.08	$180.67
11440 Removal of noncancer skin growth of face, ears, eyelids, nose, lips, or mouth, 0.5 cm or less	24	20	$150.63	$94.89
11102 Tangential biopsy of single skin lesion	22	22	$116.82	$64.78
11403 Removal of noncancer skin growth of body, arms, or legs, 2.1-3.0 cm	21	20	$240.79	$100.45
11642 Removal of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	21	18	$301.24	$228.76
11441 Removal of growth (0.6 to 1.0 centimeters) of the face, ears, eyelids, nose, lips, or mouth	19	18	$210.53	$126.50
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	18	15	$194.55	$134.81
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	18	18	$335.06	$264.82
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	17	14	$274.34	$187.65
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	16	16	$212.65	$156.69
17261 Destruction of cancer skin growth of trunk, arms, or legs, 0.6-1.0 cm	16	15	$159.08	$98.40
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	15	15	$532.39	$427.12
11400 Removal of growth (0.5 centimeters or less) of the trunk, arms or legs	15	13	$136.09	$74.46
11301 Shaving of skin growth of body, arms, or legs, 0.6-1.0 cm	15	12	$131.05	$67.76
17110 Destruction of up to 14 skin growths	14	14	$120.08	$88.97
11601 Removal of malignant growth (0.6 to 1.0 centimeters) of the trunk, arms, or legs	13	12	$253.25	$151.32
11442 Removal of noncancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	13	12	$209.69	$97.20
11422 Removal of noncancer skin growth of scalp, neck, hands, feet, or genitals, 1.1-2.0 cm	13	13	$196.83	$110.85
11302 Shaving of skin growth of body, arms, or legs, 1.1-2.0 cm	13	13	$153.56	$112.18
11311 Shaving of skin growth of face, ears, eyelids, nose, lips, or mouth, 0.6-1.0 cm	12	11	$149.16	$96.74
11421 Removal of noncancer skin growth of scalp, neck, hands, feet, or genitals, 0.6-1.0 cm	11	11	$174.27	$122.99

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	517	283	$50.01	$40.64
99213 Established patient office or other outpatient visit, typically 15 minutes	220	177	$82.42	$67.95
99202 New patient office or other outpatient visit, typically 20 minutes	124	124	$84.12	$69.83
11402 Removal of noncancer skin growth of body, arms, or legs, 1.1-2.0 cm	44	41	$201.02	$124.06
11441 Removal of growth (0.6 to 1.0 centimeters) of the face, ears, eyelids, nose, lips, or mouth	38	32	$182.58	$124.81
11401 Removal of noncancer skin growth of body, arms, or legs, 0.6-1.0 cm	36	31	$171.87	$87.87
11642 Removal of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	24	20	$299.29	$198.70
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	23	23	$131.33	$102.26
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	22	19	$274.44	$211.73
11442 Removal of noncancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	22	20	$204.62	$113.80
11301 Shaving of skin growth of body, arms, or legs, 0.6-1.0 cm	22	22	$129.16	$84.56
11440 Removal of noncancer skin growth of face, ears, eyelids, nose, lips, or mouth, 0.5 cm or less	21	18	$159.37	$86.17
11400 Removal of growth (0.5 centimeters or less) of the trunk, arms or legs	21	14	$138.48	$65.17
11641 Removal of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 0.6-1.0 cm	21	20	$261.22	$187.58
11403 Removal of noncancer skin growth of body, arms, or legs, 2.1-3.0 cm	20	15	$213.99	$114.64
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	19	19	$132.95	$101.26
12051 Intermediate repair of wound of face, ears, eyelids, nose, lips, or mouth, 2.5 cm or less	18	18	$283.24	$210.51
11311 Shaving of skin growth of face, ears, eyelids, nose, lips, or mouth, 0.6-1.0 cm	18	16	$153.13	$61.72
11601 Removal of malignant growth (0.6 to 1.0 centimeters) of the trunk, arms, or legs	17	15	$253.08	$146.61
11421 Removal of noncancer skin growth of scalp, neck, hands, feet, or genitals, 0.6-1.0 cm	16	16	$169.37	$116.35
11100 Biopsy of single growth of skin and/or tissue	15	15	$128.71	$83.42
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	13	12	$328.74	$263.23
11302 Shaving of skin growth of body, arms, or legs, 1.1-2.0 cm	12	12	$158.99	$73.94
11310 Shaving of 0.5 centimeters or less skin growth of face, ears, eyelids, nose, lips, or mouth	11	11	$124.74	$73.05

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	421	252	$50.40	$40.29
99213 Established patient office or other outpatient visit, typically 15 minutes	140	130	$86.28	$66.02
99202 New patient office or other outpatient visit, typically 20 minutes	100	100	$83.94	$69.72
11401 Removal of noncancer skin growth of body, arms, or legs, 0.6-1.0 cm	44	34	$163.12	$93.94
11402 Removal of noncancer skin growth of body, arms, or legs, 1.1-2.0 cm	27	24	$180.72	$118.64
11441 Removal of growth (0.6 to 1.0 centimeters) of the face, ears, eyelids, nose, lips, or mouth	26	24	$196.68	$112.34
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	23	23	$117.66	$101.90
11100 Biopsy of single growth of skin and/or tissue	20	20	$112.12	$70.11
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	20	16	$271.47	$181.45
12051 Intermediate repair of wound of face, ears, eyelids, nose, lips, or mouth, 2.5 cm or less	16	15	$281.31	$212.53
11641 Removal of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 0.6-1.0 cm	16	15	$259.92	$147.15
11442 Removal of noncancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	16	15	$203.50	$105.10
11403 Removal of noncancer skin growth of body, arms, or legs, 2.1-3.0 cm	16	13	$241.62	$111.52
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	15	14	$374.61	$275.54
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	15	12	$1.81	$1.77
11301 Shaving of skin growth of body, arms, or legs, 0.6-1.0 cm	13	13	$130.22	$77.92
11440 Removal of noncancer skin growth of face, ears, eyelids, nose, lips, or mouth, 0.5 cm or less	12	11	$144.98	$94.11
11642 Removal of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	12	11	$360.76	$196.86
11421 Removal of noncancer skin growth of scalp, neck, hands, feet, or genitals, 0.6-1.0 cm	12	11	$199.70	$116.61
12052 Repair of wound (2.6 to 5.0 centimeters) of face, ears, eyelids, nose, lips, and/or mouth	12	12	$320.84	$219.93

Medical Specialties & State Licenses

CMS Verified: 2020-09-02

Plastic Surgery Primary Specialty

NUCC Taxonomy Code: 208200000X

State License FL ME64978

A plastic surgeon deals with the repair, reconstruction or replacement of physical defects of form or function involving the skin, musculoskeletal system, craniomaxillofacial structures, hand, extremities, breast and trunk and external genitalia or cosmetic enhancement of these areas of the body. Cosmetic surgery is an essential component of plastic surgery. The plastic surgeon uses cosmetic surgical principles to both improve overall appearance and to optimize the outcome of reconstructive procedures. The surgeon uses aesthetic surgical principles not only to improve undesirable qualities of normal structures but in all reconstructive procedures as well.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

40 Associated Practitioners

Katherine Walsh , PA-C, MPH

Physician Assistant

NPI 1003015280

Physician Assistant (Certified), Master of Public Health

Dr. Jami Kinnucan , MD

Internal Medicine - Gastroenterology

NPI 1003045634

Doctor of Medicine (M.D.)

Dr. Glenn Shi , MD

Orthopaedic Surgery

NPI 1003058660

Doctor of Medicine (M.D.)

Dr. Michelle Tulang , MD

Internal Medicine

NPI 1003073586

Doctor of Medicine (M.D.)

Dr. Ricardo Pagan , MD

Hospitalist

NPI 1003100520

Doctor of Medicine (M.D.)

Crystal Lynn , CRNA

Nurse Anesthetist, Certified Registered

NPI 1003148768

Certified Registered Nurse Anesthetist

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

11 Historical Events

✅

NPI Profile Active December 13, 2017

NPI status registered as active in NPPES database

📍

Updated Practice Location December 13, 2017

Registered at 4500 SAN PABLO RD S, JACKSONVILLE, FL 322241865 (Tel: 9049532000)

📍

Updated Business Mailing Address December 13, 2017

Registered at 4500 SAN PABLO RD S, JACKSONVILLE, FL 322241865

👤

Provider Name / Credentials Updated December 13, 2017

Recorded as JAMES WALDORF, MD

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) December 13, 2017

Plastic Surgery (License #ME64978 in FL)

✅

NPI Profile Active July 08, 2007

NPI status registered as active in NPPES database

📍

Updated Practice Location July 08, 2007

Registered at 4500 SAN PABLO RD S, JACKSONVILLE, FL 322241865 (Tel: 9049532000)

📍

Updated Business Mailing Address July 08, 2007

Registered at 4500 SAN PABLO RD S, JACKSONVILLE, FL 322241865 (Tel: 9049532000)

👤

Provider Name / Credentials Updated July 08, 2007

Recorded as JAMES WALDORF, M.D.

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) July 08, 2007

Plastic Surgery (License #ME64978 in FL)

🟢

Initial NPI Registration & Enumeration October 22, 2005

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1780674606

Entity Type:

Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)

Enumeration Date: October 22, 2005

Last Update: September 02, 2020

Sole Proprietor: No

Update or Correct Profile

Mailing Address

4500 San Pablo Rd S

Jacksonville, FL 322241865

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).

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