Healthcare Provider Details

I. General information

NPI: 1396727277
Provider Name (Legal Business Name): CANTONMENT MEDICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

748 N HIGHWAY 29
CANTONMENT FL
32533-9513
US

IV. Provider business mailing address

748 N HIGHWAY 29
CANTONMENT FL
32533-9513
US

V. Phone/Fax

Practice location:
  • Phone: 850-937-4004
  • Fax: 850-937-4006
Mailing address:
  • Phone: 850-937-4004
  • Fax: 850-937-4006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME87968
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME70527
License Number StateFL

VIII. Authorized Official

Name: DR. FADEL SALIB
Title or Position: OWNER
Credential: MD
Phone: 850-937-4004