Healthcare Provider Details

I. General information

NPI: 1528627882
Provider Name (Legal Business Name): ANCHOR MULTISPECIALTY GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2019
Last Update Date: 07/19/2023
Certification Date: 07/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 S PALAFOX ST UNIT 103
PENSACOLA FL
32502-5983
US

IV. Provider business mailing address

890 S PALAFOX ST UNIT 300
PENSACOLA FL
32502-5905
US

V. Phone/Fax

Practice location:
  • Phone: 850-433-6760
  • Fax: 850-433-1996
Mailing address:
  • Phone: 850-433-1656
  • Fax: 850-433-1996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: KEVIN N GROOM
Title or Position: DIRECTOR
Credential: PHD
Phone: 850-433-1656