=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013000165
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GULF COAST ORTHOPEDIC SPECIALISTS PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2006
-----------------------------------------------------
Last Update Date | 05/19/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4541 N DAVIS HWY SUITE A
-----------------------------------------------------
City | PENSACOLA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32503
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-494-9000
-----------------------------------------------------
Fax | 850-479-4258
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4541 N DAVIS HWY SUITE A
-----------------------------------------------------
City | PENSACOLA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32503
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-494-9000
-----------------------------------------------------
Fax | 850-479-4258
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SURGEON PARTNER
-----------------------------------------------------
Name | ROBERT B CAMERON
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 850-494-9000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------