Healthcare Provider Details

I. General information

NPI: 1811182546
Provider Name (Legal Business Name): COASTAL CARDIOVASCULAR SURGEONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2007
Last Update Date: 09/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 E 6TH ST SUITE 309
PANAMA CITY FL
32401-3661
US

IV. Provider business mailing address

801 E 6TH ST SUITE 309
PANAMA CITY FL
32401-3661
US

V. Phone/Fax

Practice location:
  • Phone: 850-785-9559
  • Fax: 850-785-7747
Mailing address:
  • Phone: 850-785-9559
  • Fax: 850-785-7747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME66264
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME66118
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME0049047
License Number StateFL

VIII. Authorized Official

Name: DR. JOHN M KESSINGER
Title or Position: PRESIDENT
Credential: MD
Phone: 850-785-9559