=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184689895
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALBERT F MAPP JR. MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/18/2006
-----------------------------------------------------
Last Update Date | 05/07/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 489 N TYNDALL PKWY
-----------------------------------------------------
City | PANAMA CITY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32404-6126
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-763-5689
-----------------------------------------------------
Fax | 850-913-8046
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 489 N TYNDALL PKWY
-----------------------------------------------------
City | PANAMA CITY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32404-6126
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-763-5689
-----------------------------------------------------
Fax | 850-913-8046
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | ME0047609
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | MD16758
-----------------------------------------------------
License Number State | DC
-----------------------------------------------------