Bachista, Kerry Mark

Bachista, Kerry Mark is an individual health care provider with primary practice located at 4500 San Pablo Rd S , Jacksonville FL 32224-1865. He recently has only one registered license in Allopathic & Osteopathic Physicians / Emergency Medicine, which is considered as his primary health care specialty. Bachista, Kerry Mark can be contacted via phone (904) 953-2000.

Contact Information

Primary practice address
4500 San Pablo Rd S Jacksonville FL 32224-1865
Phone: (904) 953-2000
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X ME101449 Florida
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X 60790 Georgia
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X TRN9208 Florida

Profile Details

NPI number 1891845798
LBN Legal business name Bachista, Kerry Mark
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 11th, 2007
Last updated Nov 17th, 2022 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1891845798 NPPES
Florida MEDICAID 2813769-00
Florida Other 41057

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