Active NPI
Calvin Mah, M.D.
- Family Medicine Physician
- Jacksonville, FL
National Provider Identifier
1487642294
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- ME91088
- Practice address
- 11808 San Jose Blvd Ste 3
Jacksonville, FL 32223-1862 - Phone
- (904) 854-9600
- Fax
- (904) 854-4667
- NPI assigned
- Oct 6, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | ME91088 | FL | Primary |
Addresses
Primary practice location
11808 San Jose Blvd Ste 3
Jacksonville, FL 32223-1862
Mailing address
PMB #140
9838 Old Baymeadows Rd.
Jacksonville, FL 32256
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 16846 | Other | FL | BCBS NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME91088 | FL | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1128556800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1487642294",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PMB #140",
"address_2": "9838 OLD BAYMEADOWS RD.",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "32256"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11808 SAN JOSE BLVD STE 3",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322231862",
"telephone_number": "904-854-9600",
"fax_number": "904-854-4667"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAH",
"first_name": "CALVIN",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-10-06",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "FL",
"license": "ME91088",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS NUMBER",
"identifier": "16846",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.