Jacksonville Physical Medicine LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

ME88018 Issued in FL

Legal business name

JACKSONVILLE PHYSICAL MEDICINE LLC

Practice address

7860 Gate Pkwy Ste 106
Jacksonville, FL 32256-7280

Phone

(904) 619-2703

Fax

(904) 619-2837

NPI assigned

Jan 21, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jeremiah W. Carlson

Title

Owner

Phone

(904) 619-2703

Specialties & licenses 2

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1358726400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1358726400000",
    "number": "1205174695",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7860 GATE PKWY STE 106",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322567280",
            "telephone_number": "904-619-2703",
            "fax_number": "904-619-2837"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7860 GATE PKWY STE 106",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322567280",
            "telephone_number": "904-619-2703",
            "fax_number": "904-619-2837"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSONVILLE PHYSICAL MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-21",
        "last_updated": "2013-01-21",
        "status": "A",
        "authorized_official_last_name": "CARLSON",
        "authorized_official_first_name": "JEREMIAH",
        "authorized_official_middle_name": "W.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "904-619-2703",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME88018",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": "ARNP9278608",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Jacksonville, FL
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• Internal Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.