| Entity Name: | JEREMY CAUDILL, DO, L.L.C. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 10 Apr 2017 (8 years ago) |
| Document Number: | L17000079253 |
| FEI/EIN Number | 821122533 |
| Address: | 2460 OLD MOULTRIE ROAD, SAINT AUGUSTINE, FL, 32086, US |
| Mail Address: | 2460 OLD MOULTRIE ROAD, SAINT AUGUSTINE, FL, 32086, US |
| ZIP code: | 32086 |
| County: | St. Johns |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1437684032 | 2017-04-21 | 2017-06-01 | 2460 OLD MOULTRIE RD STE 3, ST AUGUSTINE, FL, 320864198, US | 2460 OLD MOULTRIE RD STE 3, ST AUGUSTINE, FL, 320864198, US | |||||||||||||||||||||||||
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| Phone | +1 904-797-6627 |
| Fax | 8886409997 |
Authorized person
| Name | DR. JEREMY ALAN CAUDILL |
| Role | PRESIDENT |
| Phone | 9047976627 |
Taxonomy
| Taxonomy Code | 208600000X - Surgery Physician |
| License Number | OS10861 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAL LICENSE |
| Number | OS10861 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| CAUDILL JEREMY A | Agent | 14 Coquina Blvd, SAINT AUGUSTINE, FL, 32080 |
| Name | Role | Address |
|---|---|---|
| Caudill Jeremy | President | 2460 OLD MOULTRIE ROAD, SAINT AUGUSTINE, FL, 32086 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2024-01-24 | 14 Coquina Blvd, SAINT AUGUSTINE, FL 32080 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2017-07-11 | 2460 OLD MOULTRIE ROAD, SUITE 3, SAINT AUGUSTINE, FL 32086 | No data |
| CHANGE OF MAILING ADDRESS | 2017-07-11 | 2460 OLD MOULTRIE ROAD, SUITE 3, SAINT AUGUSTINE, FL 32086 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-24 |
| ANNUAL REPORT | 2023-02-10 |
| ANNUAL REPORT | 2022-01-20 |
| ANNUAL REPORT | 2021-01-27 |
| ANNUAL REPORT | 2020-01-17 |
| ANNUAL REPORT | 2019-02-06 |
| ANNUAL REPORT | 2018-01-26 |
| Florida Limited Liability | 2017-04-10 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
