Healthcare Provider Details

I. General information

NPI: 1538229273
Provider Name (Legal Business Name): BLUEWATER ORTHOPEDICS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 03/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7720 HWY 98 W SUITE 200
DESTIN FL
32550-7321
US

IV. Provider business mailing address

1950 BLUEWATER BLVD SUITE 100
NICEVILLE FL
32578-3887
US

V. Phone/Fax

Practice location:
  • Phone: 850-622-3713
  • Fax: 850-622-3721
Mailing address:
  • Phone: 850-897-8081
  • Fax: 850-897-1520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. TERRI P MARKOWSKI
Title or Position: BUSINESS MANAGER
Credential:
Phone: 850-897-8081