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General NPI Number Information
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NPI Number | 1053566380
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Entity Type | Organization
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Legal Business Name | PMMDOC INC
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Dates
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Enumeration Date | 12/01/2008
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Last Update Date | 04/30/2010
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Provider Practice Location Address
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Address Line | 6435 DUNLIETH PLACE
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City | PENSACOLA
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State | FL
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Zip | 32504-7887
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Country | US
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Telephone | 850-478-0240
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Fax | 850-478-0502
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Provider Business Mailing Address
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Address Line | 6435 DUNLIETH PLACE
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City | PENSACOLA
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State | FL
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Zip | 32504-7887
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Country | US
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Telephone | 850-478-0240
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Fax | 850-478-0502
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Authorized Official
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Title or Position | PRESIDENT
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Name | PETER MICHAEL MANIS
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Credential | M.D.
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Telephone | 850-478-0240
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207PE0004X
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Taxonomy Name | Emergency Medical Services (Emergency Medicine) Physician
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License Number | ME38433
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License Number State | FL
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