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NPI Code Detail

MEDICARE: NORTHWEST FLORIDA PHYSICIANS GROUP, LLC

MEDICARE: NORTHWEST FLORIDA PHYSICIANS GROUP, 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
1207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1538594262
Entity Type Code : Organization
Provider Name (Legal Business Name) : NORTHWEST FLORIDA PHYSICIANS GROUP, LLC
Provider Business Mailing Address
First Line : 730 N NEW WARRINGTON RD
Second Line :
City : PENSACOLA
State : FL
Zip : 32506-4247
Country : US
Telephone Number : 850-456-4788
Fax Number :
Provider Business Practice Location Address
First Line : 730 N NEW WARRINGTON RD
Second Line :
City : PENSACOLA
State : FL
Zip : 32506-4247
Country : US
Telephone Number : 850-456-4788
Fax Number :
Authorized Official
Title or Position : PRES/OWNER
Name : DR. THOMAS ALLEN ROBERTS
Credential : DC
Telephone Number : 850-607-2363
Provider Enumeration Date : 09/12/2013
Last Update Date : 09/12/2013

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