Healthcare Provider Details

I. General information

NPI: 1871590158
Provider Name (Legal Business Name): DON K NAKAYAMA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 12/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5153 N 9TH AVE SUITE 307
PENSACOLA FL
32504-8785
US

IV. Provider business mailing address

PO BOX 2699
PENSACOLA FL
32513-2699
US

V. Phone/Fax

Practice location:
  • Phone: 850-416-7119
  • Fax: 850-416-6142
Mailing address:
  • Phone: 850-416-7119
  • Fax: 850-416-6142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License NumberME125547
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: