Healthcare Provider Details

I. General information

NPI: 1013452804
Provider Name (Legal Business Name): COMPREHENSIVE ORTHOPAEDICS OF THE GULF COAST, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2017
Last Update Date: 07/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3298 SUMMIT BLVD STE 4
PENSACOLA FL
32503
US

IV. Provider business mailing address

3298 SUMMIT BLVD STE 4
PENSACOLA FL
32503-4350
US

V. Phone/Fax

Practice location:
  • Phone: 850-492-7775
  • Fax: 888-974-1051
Mailing address:
  • Phone: 850-492-7775
  • Fax: 888-974-1051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JASON ROCHA
Title or Position: PRESIDENT
Credential: MD
Phone: 850-492-7775