Healthcare Provider Details

I. General information

NPI: 1063755239
Provider Name (Legal Business Name): GULF COAST RADIATION AND RADIOSURGERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2013
Last Update Date: 04/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5151 N 9TH AVE
PENSACOLA FL
32504-8721
US

IV. Provider business mailing address

29653 ANCHOR CROSS BLVD
DAPHNE AL
36526-9594
US

V. Phone/Fax

Practice location:
  • Phone: 251-626-1755
  • Fax: 251-626-9355
Mailing address:
  • Phone: 251-626-1712
  • Fax: 251-626-9355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberME108535
License Number StateFL

VIII. Authorized Official

Name: DR. STEPHEN SAWRIE
Title or Position: PRESIDENT
Credential: MD
Phone: 251-626-1712