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General NPI Number Information
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NPI Number | 1184173338
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Entity Type | Organization
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Legal Business Name | PANHANDLE SURGICAL SERVICES
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Dates
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Enumeration Date | 09/29/2016
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Last Update Date | 03/28/2017
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Provider Practice Location Address
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Address Line | 2202 STATE AVE STE 104
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City | PANAMA CITY
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State | FL
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Zip | 32405-7601
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Country | US
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Telephone | 850-640-3320
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Fax |
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Provider Business Mailing Address
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Address Line | 2202 STATE AVE STE 104
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City | PANAMA CITY
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State | FL
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Zip | 32405-7601
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Country | US
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Telephone | 850-640-3320
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MS. DOTTIE CLARK
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Credential |
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Telephone | 850-640-3320
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | ME102627
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License Number State | FL
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