Healthcare Provider Details

I. General information

NPI: 1790932473
Provider Name (Legal Business Name): ANDREWS FOUNDATION FOR RESEARCH & EDUCATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2008
Last Update Date: 08/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 GULF BREEZE PKWY SUITE 200
GULF BREEZE FL
32561-7809
US

IV. Provider business mailing address

1717 N E ST SUITE 320
PENSACOLA FL
32501-6339
US

V. Phone/Fax

Practice location:
  • Phone: 850-916-3700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH G. FELKNER
Title or Position: PRESIDENT
Credential:
Phone: 850-434-4011