Caudill, Jeremy Alan
Caudill, Jeremy Alan is an sole proprietor health care provider with primary practice located at 2460 Old Moultrie Rd Ste 3 , Saint Augustine FL 32086-4198. He recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as his primary health care specialty. Caudill, Jeremy Alan can be contacted via phone (904) 797-6627.Contact Information
Primary practice address
2460 Old Moultrie Rd Ste 3
Saint Augustine FL 32086-4198
Phone: (904) 797-6627
Fax: (386) 328-4125
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Surgery | 208600000X | OS10861 | Florida |
Profile Details
| NPI number | 1265650295 |
|---|---|
| LBN Legal business name | Caudill, Jeremy Alan |
| Credentials | Doctor of Osteopathy (DO) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Apr 23rd, 2007 |
| Last updated | Jul 16th, 2019 - about 7 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1265650295 | NPPES |
| Florida | MEDICAID | 003413200 | |
| Florida | MEDICAID | 002389800 |
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