| Entity Name: | W.P. BOORAS, M.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 01 Oct 1979 (45 years ago) |
| Document Number: | 637892 |
| FEI/EIN Number | 591937691 |
| Address: | 1922 UNIVERSITY BLVD.,S., JACKSONVILLE, FL, 32216 |
| Mail Address: | 1922 UNIVERSITY BLVD.,S., JACKSONVILLE, FL, 32216 |
| ZIP code: | 32216 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1437221033 | 2006-11-15 | 2008-07-02 | 1922 UNIVERSITY BLVD S, JACKSONVILLE, FL, 322168933, US | 1922 UNIVERSITY BLVD S, JACKSONVILLE, FL, 322168933, US | |||||||||||||||||||||||||||||||
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| Phone | +1 904-721-7844 |
| Fax | 9047273597 |
Authorized person
| Name | CHARLES H BOORAS |
| Role | PRESIDENT |
| Phone | 9047217844 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | ME0040719 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | PALMETTO GBA - RAILROAD |
| Number | 080025632 |
| State | GA |
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | 15776 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BOORAS, W.P., M.D. | Agent | 1922 UNIVERSITY BLVD.,S., JACKSONVILLE, FL, 32216 |
| Name | Role | Address |
|---|---|---|
| BOORAS CHARLES H | President | 1922 UNIVERSITY BLVD S, JACKSONVILLE, FL, 32216 |
| Name | Role | Address |
|---|---|---|
| BOORAS CHARLES H | Director | 1922 UNIVERSITY BLVD S, JACKSONVILLE, FL, 32216 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2009-09-25 | No data | No data |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
