| Entity Name: | LIVE OAK MEDICAL ASSOCIATES, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Inactive |
| Date Filed: | 19 Mar 1996 (29 years ago) |
| Date of dissolution: | 07 Dec 2017 (7 years ago) |
| Last Event: | VOLUNTARY DISS W/ NOTICE |
| Event Date Filed: | 07 Dec 2017 (7 years ago) |
| Document Number: | P96000024484 |
| FEI/EIN Number | 59-3387916 |
| Address: | 2896 GULF BREEZE PKWY, GULF BREEZE, FL 32563 |
| Mail Address: | 2896 GULF BREEZE PKWY, GULF BREEZE, FL 32563 |
| ZIP code: | 32563 |
| County: | Santa Rosa |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1003951138 | 2007-02-20 | 2008-04-20 | 2896 GULF BREEZE PKWY, GULF BREEZE, FL, 325633146, US | 2896 GULF BREEZE PKWY, GULF BREEZE, FL, 325633146, US | |||||||||||||||||||||
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| Phone | +1 850-932-2203 |
| Fax | 8509340050 |
Authorized person
| Name | EDWARD R HALFON |
| Role | ADMINISTRATOR |
| Phone | 8509322203 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | RAILROAD MEDICARE |
| Number | CD1897 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| ZIMMERN, WILLIAM AJR. | Agent | 2896 GULF BREEZE PKWY, GULF BREEZE, FL 32561 |
| Name | Role | Address |
|---|---|---|
| ZIMMERN, WILLIAM AJR | Director | 2896 GULF BREEZE PKWY, GULF BREEZE, FL 32561 |
| KELLEN, DAVID P | Director | 2896 GULF BREEZE PKWY, GULF BREEZE, FL 32563 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G09000103753 | LIVE OAK MEDICAL ASSOCIATES | EXPIRED | 2009-05-04 | 2014-12-31 | No data | 2896 GULF BREEZE PARKWAY, GULF BREEZE, FL, 32563 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISS W/ NOTICE | 2017-12-07 | No data | No data |
| REINSTATEMENT | 2013-02-27 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2012-09-28 | No data | No data |
| REINSTATEMENT | 2011-10-04 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2011-09-23 | No data | No data |
| CANCEL ADM DISS/REV | 2010-01-07 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2009-09-25 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2006-02-23 | 2896 GULF BREEZE PKWY, GULF BREEZE, FL 32563 | No data |
| CHANGE OF MAILING ADDRESS | 2006-02-23 | 2896 GULF BREEZE PKWY, GULF BREEZE, FL 32563 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2006-02-23 | 2896 GULF BREEZE PKWY, GULF BREEZE, FL 32561 | No data |
| Name | Date |
|---|---|
| CORAPVDWN | 2017-12-07 |
| ANNUAL REPORT | 2017-01-09 |
| ANNUAL REPORT | 2016-03-03 |
| AMENDED ANNUAL REPORT | 2015-06-17 |
| ANNUAL REPORT | 2015-02-04 |
| ANNUAL REPORT | 2014-02-28 |
| REINSTATEMENT | 2013-02-27 |
| REINSTATEMENT | 2011-10-04 |
| CORAPREIWP | 2010-01-07 |
| ANNUAL REPORT | 2008-02-25 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
