Provider Demographics
NPI:1447520747
Name:NORTH EAST FLORIDA ENDOCRINE AND DIABETES ASSOCIATION
Entity type:Organization
Organization Name:NORTH EAST FLORIDA ENDOCRINE AND DIABETES ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPM
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHOEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:904-384-2240
Mailing Address - Street 1:1635 EAGLE HARBOR PKWY STE 5
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32003-4827
Mailing Address - Country:US
Mailing Address - Phone:904-384-2240
Mailing Address - Fax:904-385-7777
Practice Address - Street 1:1635 EAGLE HARBOR PKWY STE 5
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32003-4827
Practice Address - Country:US
Practice Address - Phone:904-384-2240
Practice Address - Fax:904-385-7777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-04
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5497720001332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL37460620Medicaid
FL77240Medicare PIN