Healthcare Provider Details

I. General information

NPI: 1316383912
Provider Name (Legal Business Name): GPD PATHOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2013
Last Update Date: 09/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1710 LISENBY AVE
PANAMA CITY FL
32405-3730
US

IV. Provider business mailing address

1710 LISENBY AVE
PANAMA CITY FL
32405-3730
US

V. Phone/Fax

Practice location:
  • Phone: 850-248-7284
  • Fax:
Mailing address:
  • Phone: 850-248-7284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: DR. JON WARD
Title or Position: PRESIDENT
Credential: M.D.
Phone: 850-248-7284