Caudill, Jeremy Alan

Caudill, Jeremy Alan is an sole proprietor health care provider with primary practice located at 2460 Old Moultrie Rd Ste 3 , Saint Augustine FL 32086-4198. He recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as his primary health care specialty. Caudill, Jeremy Alan can be contacted via phone (904) 797-6627.

Contact Information

Primary practice address
2460 Old Moultrie Rd Ste 3 Saint Augustine FL 32086-4198
Phone: (904) 797-6627
Fax: (386) 328-4125
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Surgery 208600000X OS10861 Florida

Profile Details

NPI number 1265650295
LBN Legal business name Caudill, Jeremy Alan
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Apr 23rd, 2007
Last updated Jul 16th, 2019 - about 5 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 1265650295 NPPES
Florida MEDICAID 003413200
Florida MEDICAID 002389800

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