Lara Diane Church M.D.

NPI 1043280449 - Family Medicine - 207Q00000X

NPI Details
NPI 1043280449
Gender Female
Enumeration Date 01/26/2006
Last Updated 11/16/2015
Entity Type Individual
Active Over 10 years ago
Practice Location
141 HILDEN RD STE 201
CREDENTIALING DEPARTMENT
PONTE VEDRA FL, 32081-8400, US
Phone (904) 825-1941
Fax (904) 829-2850
Business Location
PO BOX 44004
JACKSONVILLE FL, 32231-4004, US
Phone (904) 202-1032
Fax (904) 391-5807
Toxanomy
Taxonomy Code 207Q00000X
License State Florida
License Number ME105548
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According to our database, Dr. Lara Diane Church M.D. NPI is 1043280449, taxonomy code is 207Q00000X and license number is ME105548, license state is located at Florida. Lara Diane Church M.D. physically located at 141 Hilden Rd Ste 201, Ponte Vedra FL, 32081-8400. NPI Number Lara Diane Church M.D. has the Individual type.

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1043280449 NPI number is provided on an as is basis without warranty of any kind. 1043280449 is maintained by the National Plan & Provider Enumeration System. The contents of Lara Diane Church M.D. are for informational purposes only.