Healthcare Provider Details

I. General information

NPI: 1184761538
Provider Name (Legal Business Name): WHITE-WILSON MEDICAL CENTER, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

990 AIRPORT RD PEDIATRIC DEPARTMENT
DESTIN FL
32541-2820
US

IV. Provider business mailing address

1005 MAR WALT DR BUSINESS OFFICE
FORT WALTON BEACH FL
32547-6707
US

V. Phone/Fax

Practice location:
  • Phone: 850-837-3848
  • Fax: 850-654-9581
Mailing address:
  • Phone: 850-863-8105
  • Fax: 850-863-8548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DOUGLAS W RIGBY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 850-863-8131