Healthcare Provider Details

I. General information

NPI: 1114978145
Provider Name (Legal Business Name): REGULO C CALAYCAY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5149 N 9TH AVE SUITE 246
PENSACOLA FL
32504-8756
US

IV. Provider business mailing address

PO BOX 2699
PENSACOLA FL
32513-2699
US

V. Phone/Fax

Practice location:
  • Phone: 850-416-2540
  • Fax: 850-416-2536
Mailing address:
  • Phone: 850-416-7800
  • Fax: 850-416-4937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME27297
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: