Healthcare Provider Details

I. General information

NPI: 1427174762
Provider Name (Legal Business Name): MEDICAL PROFESSIONAL AGENCY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 04/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9400 UNIVERSITY PKWY 101C
PENSACOLA FL
32514-5752
US

IV. Provider business mailing address

PO BOX 893
MILTON FL
32572-0893
US

V. Phone/Fax

Practice location:
  • Phone: 850-623-2948
  • Fax: 850-626-2734
Mailing address:
  • Phone: 850-623-2948
  • Fax: 850-626-2734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: REBECCA ROGERS
Title or Position: BILLING COORDINATOR
Credential:
Phone: 850-623-2948