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NPI Code Detail

MEDICARE: GPD PATHOLOGY LLC

MEDICARE: GPD PATHOLOGY LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1291U00000XClinical Medical Laboratory

General Provider Information

NPI Number : 1316383912
Entity Type Code : Organization
Provider Name (Legal Business Name) : GPD PATHOLOGY LLC
Provider Business Mailing Address
First Line : 1710 LISENBY AVE
Second Line :
City : PANAMA CITY
State : FL
Zip : 32405-3730
Country : US
Telephone Number : 850-248-7284
Fax Number :
Provider Business Practice Location Address
First Line : 1710 LISENBY AVE
Second Line :
City : PANAMA CITY
State : FL
Zip : 32405-3730
Country : US
Telephone Number : 850-248-7284
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : DR. JON WARD
Credential : M.D.
Telephone Number : 850-248-7284
Provider Enumeration Date : 05/22/2013
Last Update Date : 09/13/2013

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