Healthcare Provider Details

I. General information

NPI: 1194777029
Provider Name (Legal Business Name): FELIX ERMOLENKO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 02/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4451 BAYOU BLVD
PENSACOLA FL
32503-2601
US

IV. Provider business mailing address

PO BOX 2699 ATTN: SHMG/HPE
PENSACOLA FL
32513-2699
US

V. Phone/Fax

Practice location:
  • Phone: 850-416-2477
  • Fax: 850-416-7520
Mailing address:
  • Phone: 850-416-7800
  • Fax: 850-416-4937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME85126
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: