Healthcare Provider Details

I. General information

NPI: 1265497382
Provider Name (Legal Business Name): JON WILLIAM NAGEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PEDIATRIX MEDICAL GROUP, INC. 4900 BAYOU BOULEVARD #205
PENSACOLA FL
32503
US

IV. Provider business mailing address

506 KENILWORTH AVE
GULF BREEZE FL
32561-4426
US

V. Phone/Fax

Practice location:
  • Phone: 850-476-2387
  • Fax:
Mailing address:
  • Phone: 850-932-5413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberME 25823
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: