Healthcare Provider Details

I. General information

NPI: 1659549509
Provider Name (Legal Business Name): GULF COAST ORTHOPEDIC SPECIALISTS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2008
Last Update Date: 02/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3754 HIGHWAY 90 STE 300
PACE FL
32571-1098
US

IV. Provider business mailing address

4541 N DAVIS HWY STE A
PENSACOLA FL
32503-2733
US

V. Phone/Fax

Practice location:
  • Phone: 850-416-5810
  • Fax:
Mailing address:
  • Phone: 850-494-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateFL

VIII. Authorized Official

Name: ROBERT B CAMERON
Title or Position: SURGEON-PARTNER
Credential: M.D.
Phone: 850-494-9000