Healthcare Provider Details

I. General information

NPI: 1588787220
Provider Name (Legal Business Name): SURGICAL ONCOLOGY & GENERAL SUGERY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 02/09/2023
Certification Date: 02/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 MEDICAL PARK DR
ATMORE AL
36502-3016
US

IV. Provider business mailing address

PO BOX 30195
PENSACOLA FL
32503-1195
US

V. Phone/Fax

Practice location:
  • Phone: 251-368-9826
  • Fax: 251-368-3917
Mailing address:
  • Phone: 251-368-9826
  • Fax: 251-368-3917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number9132
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. WILLIAM BRUCE HARRIS
Title or Position: OWNER
Credential: M.D.
Phone: 251-368-9826