Organization Name: | WEST FLORIDA GULF COAST PRIMARY CARE |
NPI Number: | 1801109178 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JASON K HARVEY (EXECUTIVE DIRECTOR) |
Mailing Address: | 1921 E Nine Mile Rd Pensacola |
State: | FL US |
Postal Code: | 325147747 |
Phone Number: | 8504794858 |
Fax Number: | 8504942260 |
NPI Enumeration Date: | 07/15/2010 |
NPI Last Update Date: | 07/15/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |