NPI 1417024936 · live from the CMS NPI Registry
Randall Scott Anselmo, MD
Family Medicine in St Augustine, FL. National Provider Identifier 1417024936, active.
NPI record
| NPI | 1417024936 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Family Medicine 207Q00000X |
| Practice location | 130 Health Park Blvd, St Augustine, FL 32086 |
| Practice phone | 904-826-3469 |
| Mailing address | 417 Marsh Point Cir, St Augustine, FL 32080 |
| Enumerated | November 29, 2006 |
| Last updated | February 6, 2024 |
| Sole proprietor | Yes |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Family Medicine primary | 207Q00000X | 042-0010651 (VT) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.