Provider Demographics
NPI:1154394625
Name:CAROLINE, JOHN M (DO)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:CAROLINE
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:619 S MARION AVE
Mailing Address - Street 2:NF/SG VHS PRIMARY CARE LAKE CITY VA MEDICAL CENTER
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32025-5808
Mailing Address - Country:US
Mailing Address - Phone:386-755-3016
Mailing Address - Fax:386-754-7395
Practice Address - Street 1:619 S MARION AVE
Practice Address - Street 2:NF/SG VHS PRIMARY CARE LAKE CITY VA MEDICAL CENTER
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-5808
Practice Address - Country:US
Practice Address - Phone:386-755-3016
Practice Address - Fax:386-754-7395
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2015-08-31
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Provider Licenses
StateLicense IDTaxonomies
FLOS9028207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL82185OtherBCBS
FL268168400Medicaid
FL291496OtherAVMED
FLH98542Medicare UPIN
FL268168400Medicaid