Healthcare Provider Details

I. General information

NPI: 1023088291
Provider Name (Legal Business Name): ERIC JOHN KUJAWSKI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 10/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4541 N DAVIS HWY STE A
PENSACOLA FL
32503-2733
US

IV. Provider business mailing address

PO BOX 2699
PENSACOLA FL
32513-2699
US

V. Phone/Fax

Practice location:
  • Phone: 850-494-9000
  • Fax:
Mailing address:
  • Phone: 850-475-4500
  • Fax: 850-475-4781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberOS11328
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: