Fern, Samuel J.

Fern, Samuel J. is an individual health care provider with primary practice located at 900 Beach Blvd Credentialing Department, Jacksonville Beach FL 32250-4368. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Fern, Samuel J. can be contacted via phone (904) 249-0335.

Contact Information

Primary practice address
900 Beach Blvd Credentialing Department Jacksonville Beach FL 32250-4368
Phone: (904) 249-0335
Fax: (904) 249-0347
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X OS6092 Florida

Profile Details

NPI number 1437136074
LBN Legal business name Fern, Samuel J.
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 26th, 2005
Last updated Nov 25th, 2015 - about 10 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 1437136074 NPPES
Florida MEDICAID 3704556-00

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