Ebm Internal Medicine Inc

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

ME95409 Issued in FL

Legal business name

EBM INTERNAL MEDICINE INC

Practice address

5851 Timuquana Rd
Suite 303
Jacksonville, FL 32210-7878

Phone

(904) 674-2699

Fax

(904) 674-6710

NPI assigned

Mar 7, 2007

Last updated

Sep 8, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ernst Berthony Michel, M.D.

Title

Medical Director

Phone

(904) 674-2699

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1173225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1315440000000",
    "number": "1477684108",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5851 TIMUQUANA RD",
            "address_2": "SUITE 303",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322107878",
            "telephone_number": "904-674-2699",
            "fax_number": "904-674-6710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5851 TIMUQUANA RD",
            "address_2": "SUITE 303",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322107878",
            "telephone_number": "904-674-2699",
            "fax_number": "904-674-6710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EBM INTERNAL MEDICINE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-07",
        "last_updated": "2011-09-08",
        "status": "A",
        "authorized_official_last_name": "MICHEL",
        "authorized_official_first_name": "ERNST",
        "authorized_official_middle_name": "BERTHONY",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "904-674-2699",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME95409",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Internal Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2011; 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.