Unknown Individual – Pediatric Adolescent Medicine Physician, NPI 1215920590
Pediatric Adolescent Medicine Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for Unknown Individual
2121, Park Street, Riverside, Jacksonville, Duval County, Florida, 32204, United States
JACKSONVILLE, FL 322043811
Phone: (904) 387-6200
Fax: (904) 387-0261
Mailing address matches the actual address.
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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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 32204)
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