Healthcare Provider Details

I. General information

NPI: 1477322345
Provider Name (Legal Business Name): GULF COAST PLASTIC SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2023
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

539 FONTAINE ST
PENSACOLA FL
32503-2018
US

IV. Provider business mailing address

539 FONTAINE ST
PENSACOLA FL
32503-2018
US

V. Phone/Fax

Practice location:
  • Phone: 850-476-3440
  • Fax: 850-741-5099
Mailing address:
  • Phone: 850-476-3440
  • Fax: 850-741-5099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. PETER N BUTLER
Title or Position: OWNER/PLASTIC SURGEON
Credential: MD
Phone: 850-476-3223