Unknown Individual – Internal Medicine Physician, NPI 1104819796
Internal Medicine Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for Unknown Individual
1209, Dallas Avenue, Winter Park, Orange County, Florida, 32789, United States
ORANGE PARK, FL 320734158
Phone: (904) 743-0737
Fax: (386) 328-4137
Type: Mailing
301, South Palm Avenue, Palatka, Putnam County, Florida, 32177, United States
PALATKA, FL 321774143
Phone: (386) 328-7493
Fax: (386) 328-4137
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
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Medicare Enrollment & Revalidation
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Educational use only—not medical, billing, or legal advice.
No Medicare enrollment or revalidation data available for this provider in our database.
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Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
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No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 32073)
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