Healthcare Provider Details

I. General information

NPI: 1295922086
Provider Name (Legal Business Name): ALBERT F MAPP JR M D P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2007
Last Update Date: 09/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

489 N TYNDALL PKWY
PANAMA CITY FL
32404-6126
US

IV. Provider business mailing address

489 N TYNDALL PKWY
PANAMA CITY FL
32404-6126
US

V. Phone/Fax

Practice location:
  • Phone: 850-763-5689
  • Fax: 850-913-8046
Mailing address:
  • Phone: 850-763-5689
  • Fax: 850-913-8046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ALBERT F MAPP JR.
Title or Position: OWNER
Credential: MD
Phone: 850-763-5689