| Organization Name: | FM MEDICAL |
| NPI Number: | 1053652099 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SCOTT ROBERT MICHAELS (OWNER) |
| Mailing Address: | 165 Southpark Blvd Suite C & D St Augustine |
| State: | FL US |
| Postal Code: | 320864101 |
| Phone Number: | 9048238833 |
| Fax Number: | 9048239394 |
| NPI Enumeration Date: | 03/14/2013 |
| NPI Last Update Date: | 07/08/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QM1300X |
| License Number: | ME106486 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Multi-Specialty |
| Taxonomy Definition: | |