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General NPI Number Information
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NPI Number | 1013452804
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Entity Type | Organization
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Legal Business Name | COMPREHENSIVE ORTHOPAEDICS OF THE GULF COAST, LLC
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Dates
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Enumeration Date | 01/03/2017
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Last Update Date | 07/25/2018
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Provider Practice Location Address
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Address Line | 3298 SUMMIT BLVD STE 4
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City | PENSACOLA
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State | FL
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Zip | 32503
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Country | US
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Telephone | 850-492-7775
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Fax | 888-974-1051
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Provider Business Mailing Address
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Address Line | 3298 SUMMIT BLVD STE 4
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City | PENSACOLA
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State | FL
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Zip | 32503-4350
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Country | US
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Telephone | 850-492-7775
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Fax | 888-974-1051
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Authorized Official
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Title or Position | PRESIDENT
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Name | JASON ROCHA
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Credential | MD
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Telephone | 850-492-7775
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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