Active NPI
Wilford E. Paulk, M.D.
- Gynecology Physician
- Jacksonville, FL
National Provider Identifier
1861454704
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gynecology Physician
- License
- ME 48260
- Practice address
- 14546 Old Saint Augustine Rd Ste 311
Jacksonville, FL 32258-5472 - Phone
- (904) 260-2255
- Fax
- (904) 260-2251
- NPI assigned
- Apr 5, 2006
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gynecology Physician | 207VG0400X | ME 48260 | FL | Primary |
| Obstetrics & Gynecology Physician | 207V00000X | ME48260 | FL |
Addresses
Primary practice location
14546 Old Saint Augustine Rd Ste 311
Jacksonville, FL 32258-5472
Mailing address
PO Box 25317
Tampa, FL 33622-5317
Phone (813) 286-0033
Other practice location 1
10898 Baymeadows Rd Ste 200
Jacksonville, FL 32256-5838
Phone (904) 260-2255
Other practice location 2
9404 Waypoint Pl
Jacksonville, FL 32257-5588
Phone (904) 260-2255
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 064742000 | Medicaid | FL |
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 |
|---|---|---|---|
| ME 48260 | FL | MD | Gynecology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144195200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1551052800000",
"number": "1861454704",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 25317",
"city": "TAMPA",
"state": "FL",
"postal_code": "336225317",
"telephone_number": "813-286-0033",
"fax_number": "813-282-1806"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14546 OLD SAINT AUGUSTINE RD STE 311",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322585472",
"telephone_number": "904-260-2255",
"fax_number": "904-260-2251"
}
],
"practiceLocations": [
{
"address_1": "10898 Baymeadows Rd Ste 200",
"address_purpose": "LOCATION",
"city": "Jacksonville",
"state": "FL",
"postal_code": "322565838",
"country_code": "US",
"telephone_number": "904-260-2255",
"fax_number": "904-519-0633",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "9404 Waypoint Pl",
"address_purpose": "LOCATION",
"city": "Jacksonville",
"state": "FL",
"postal_code": "322575588",
"country_code": "US",
"telephone_number": "904-260-2255",
"fax_number": "904-739-7557",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PAULK",
"first_name": "WILFORD",
"middle_name": "E.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-05",
"last_updated": "2019-02-25",
"status": "A"
},
"taxonomies": [
{
"code": "207VG0400X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology, Gynecology",
"state": "FL",
"license": "ME 48260",
"primary": true
},
{
"code": "207V00000X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology",
"state": "FL",
"license": "ME48260",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "064742000",
"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 Feb 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.