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General NPI Number Information
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NPI Number | 1164480240
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Entity Type | Organization
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Legal Business Name | PENSACOLA EAR NOSE AND THROAT PL
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Dates
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Enumeration Date | 05/01/2006
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Last Update Date | 09/24/2014
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Provider Practice Location Address
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Address Line | 1717 NORTH E STREET STE 239
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City | PENSACOLA
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State | FL
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Zip | 32501
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Country | US
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Telephone | 850-432-3467
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Fax | 850-434-2308
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Provider Business Mailing Address
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Address Line | 1717 NORTH E STREET STE 239
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City | PENSACOLA
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State | FL
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Zip | 32501
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Country | US
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Telephone | 850-432-3467
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Fax | 850-434-2308
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Authorized Official
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Title or Position | PARTNER
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Name | DR. KEVIN BOTTS JR.
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Credential | MD
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Telephone | 850-532-3467
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number |
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License Number State |
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