Healthcare Provider Details

I. General information

NPI: 1821073719
Provider Name (Legal Business Name): LEONARD ANDREW FICHTER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11501 HUTCHISON BLVD STE 109
PANAMA CITY BEACH FL
32407-3747
US

IV. Provider business mailing address

22207 FOX GLENN TRCE
PANAMA CITY BEACH FL
32413-8413
US

V. Phone/Fax

Practice location:
  • Phone: 850-250-1311
  • Fax: 850-250-3589
Mailing address:
  • Phone: 304-545-7444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberOS15559
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License NumberOS15559
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: