Advanced Ear, Nose, Throat Associates, LLC

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

License

ME104096 Issued in FL

Legal business name

ADVANCED EAR, NOSE, THROAT ASSOCIATES, LLC

Practice address

1560 Roberts Dr
Jacksonville Beach, FL 32250-3222

Phone

(904) 339-0350

Fax

(904) 339-0351

NPI assigned

Mar 22, 2011

Organization subpart

No

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

Authorized official

Name

Kunal Thakkar, MDNPI 1306009139

Title

President

Phone

(904) 339-0350

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kunal Thakkar, M.D.

  • Otolaryngology Physician
  • Jacksonville Beach, FL
  • NPI 1306009139
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1300752000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1544054400000",
    "number": "1861791402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1560 ROBERTS DR",
            "city": "JACKSONVILLE BEACH",
            "state": "FL",
            "postal_code": "322503222",
            "telephone_number": "904-339-0350",
            "fax_number": "904-339-0351"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1560 ROBERTS DR",
            "city": "JACKSONVILLE BEACH",
            "state": "FL",
            "postal_code": "322503222",
            "telephone_number": "904-339-0350",
            "fax_number": "904-339-0351"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4205 Belfort Rd Ste 2005",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322165876",
            "country_code": "US",
            "telephone_number": "904-339-0350",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ADVANCED EAR, NOSE, THROAT ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-22",
        "last_updated": "2018-12-06",
        "status": "A",
        "authorized_official_last_name": "THAKKAR",
        "authorized_official_first_name": "KUNAL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "904-339-0350",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Otolaryngology",
            "state": "FL",
            "license": "ME104096",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Victoria Hernandez Adeeb, PT, DPT
• Adler Podiatry Clinic PLLC
• Adler Podiatry Clinic PLLC
• Adler Podiatry Clinic PLLC
• Advanced Dermatology, PA
• Jorge A Aguilar, MD
• Charmaine A Aguirre, MD
• Safia Ahmed, MD
• Christina Diane Ahrens, ARNP
• Airemed Inc.

• Otolaryngology Physician in Jacksonville Beach, FL
• Providers in Jacksonville Beach, FL by specialty
• Otolaryngology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.