Healthcare Provider Details

I. General information

NPI: 1063480143
Provider Name (Legal Business Name): DONALD SEXTON PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 03/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 REDSTONE AVE W SUITE 200
CRESTVIEW FL
32536-6430
US

IV. Provider business mailing address

PO BOX 2699
PENSACOLA FL
32513-2699
US

V. Phone/Fax

Practice location:
  • Phone: 850-682-6122
  • Fax: 850-682-5917
Mailing address:
  • Phone: 850-475-4500
  • Fax: 850-475-4619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9101215
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: