Healthcare Provider Details

I. General information

NPI: 1710554936
Provider Name (Legal Business Name): PEDIATRIX MEDICAL GROUP OF FLORIDA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2021
Last Update Date: 06/25/2021
Certification Date: 06/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5192 BAYOU BLVD
PENSACOLA FL
32503-2102
US

IV. Provider business mailing address

1301 CONCORD TER
SUNRISE FL
33323-2843
US

V. Phone/Fax

Practice location:
  • Phone: 850-484-5040
  • Fax: 855-527-5510
Mailing address:
  • Phone: 800-243-3839
  • Fax: 855-527-5510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number
License Number State

VIII. Authorized Official

Name: ALAN OLIVER
Title or Position: PRESIDENT
Credential:
Phone: 877-885-0588