Healthcare Provider Details

I. General information

NPI: 1508931502
Provider Name (Legal Business Name): BOBBY LLOYD NOWELL NBC-HIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1209 AIRPORT RD SUITE 5
DESTIN FL
32541-2949
US

IV. Provider business mailing address

1209 AIRPORT RD SUITE 5
DESTIN FL
32541-2949
US

V. Phone/Fax

Practice location:
  • Phone: 850-837-3247
  • Fax: 850-837-6460
Mailing address:
  • Phone: 850-837-3247
  • Fax: 850-837-6460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number3614
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: