Provider Demographics
NPI:1366233058
Name:GOOD SHEPHERD
Entity type:Organization
Organization Name:GOOD SHEPHERD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:VORBES
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-401-1897
Mailing Address - Street 1:181 SAINT JOHNS FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:ST JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-4067
Mailing Address - Country:US
Mailing Address - Phone:904-401-1897
Mailing Address - Fax:
Practice Address - Street 1:430 COLLEGE DR STE 113-115
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG
Practice Address - State:FL
Practice Address - Zip Code:32068-8530
Practice Address - Country:US
Practice Address - Phone:904-401-1897
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty