Healthcare Provider Details

I. General information

NPI: 1013000165
Provider Name (Legal Business Name): GULF COAST ORTHOPEDIC SPECIALISTS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 05/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4541 N DAVIS HWY SUITE A
PENSACOLA FL
32503
US

IV. Provider business mailing address

4541 N DAVIS HWY SUITE A
PENSACOLA FL
32503
US

V. Phone/Fax

Practice location:
  • Phone: 850-494-9000
  • Fax: 850-479-4258
Mailing address:
  • Phone: 850-494-9000
  • Fax: 850-479-4258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT B CAMERON
Title or Position: SURGEON PARTNER
Credential: M.D.
Phone: 850-494-9000