Healthcare Provider Details

I. General information

NPI: 1487846259
Provider Name (Legal Business Name): GULF BREEZE PSYCHIATRIC SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2007
Last Update Date: 08/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 EAST DESOTO ST
PENSACOLA FL
32501
US

IV. Provider business mailing address

1221 EAST DESOTO ST
PENSACOLA FL
32501
US

V. Phone/Fax

Practice location:
  • Phone: 850-437-9997
  • Fax: 850-439-2122
Mailing address:
  • Phone: 850-437-9997
  • Fax: 850-439-2122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME0055242
License Number StateFL

VIII. Authorized Official

Name: MICHAEL P CONRAD
Title or Position: OWNER
Credential: MD
Phone: 850-437-9997