Healthcare Provider Details

I. General information

NPI: 1285085399
Provider Name (Legal Business Name): EDIN PUJAGIC D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2016
Last Update Date: 12/27/2022
Certification Date: 12/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 N E ST STE 439
PENSACOLA FL
32501-6338
US

IV. Provider business mailing address

1717 N E ST STE 439
PENSACOLA FL
32501-6338
US

V. Phone/Fax

Practice location:
  • Phone: 850-432-3692
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberDO-05401
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: