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General NPI Number Information
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NPI Number | 1184674624
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Entity Type | Individual
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Provider Name | DAVID L TENNISWOOD MD
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Gender | Male
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Dates
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Enumeration Date | 05/12/2006
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Last Update Date | 03/03/2020
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Provider Practice Location Address
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Address Line | 619 N COVE BLVD
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City | PANAMA CITY
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State | FL
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Zip | 32401-3642
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Country | US
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Telephone | 850-913-6960
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Fax | 850-913-6961
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Provider Business Mailing Address
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Address Line | 4205 BELFORT RD STE 4015
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City | JACKSONVILLE
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State | FL
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Zip | 32216-3623
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Country | US
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Telephone | 904-450-6014
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Fax | 904-450-6401
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 0428049
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | ME108539
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License Number State | FL
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