Healthcare Provider Details

I. General information

NPI: 1912316282
Provider Name (Legal Business Name): MEDICAL FORESIGHT, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2014
Last Update Date: 08/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 N BONITA AVE
PANAMA CITY FL
32401-3623
US

IV. Provider business mailing address

PO BOX 9167
P C BEACH FL
32417-9167
US

V. Phone/Fax

Practice location:
  • Phone: 850-665-3653
  • Fax: 850-665-3654
Mailing address:
  • Phone: 850-665-3653
  • Fax: 850-665-3654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0005X
TaxonomyUndersea and Hyperbaric Medicine (Emergency Medicine) Physician
License NumberME 92292
License Number StateFL

VIII. Authorized Official

Name: JUSTIN STRITTMATTER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 850-665-3653