Healthcare Provider Details

I. General information

NPI: 1265754824
Provider Name (Legal Business Name): RAWSON & BRAXTON ORAL AND MAXILLOFACIAL SURGERY ASSOCIATES OF WEST FL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2010
Last Update Date: 02/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 AIRPORT BLVD STE B
PENSACOLA FL
32504-8622
US

IV. Provider business mailing address

1100 AIRPORT BLVD STE B
PENSACOLA FL
32504-8622
US

V. Phone/Fax

Practice location:
  • Phone: 850-477-8482
  • Fax: 850-477-7604
Mailing address:
  • Phone: 850-477-8482
  • Fax: 850-477-7604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: MRS. ELLA MANZIEK
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 850-477-8482