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General NPI Number Information
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NPI Number | 1265477574
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Entity Type | Organization
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Legal Business Name | EMERALD COAST EAR, NOSE, THROAT & ALLERGIES, P.A.
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Dates
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Enumeration Date | 06/19/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1032 MAR WALT DR SUITE 100
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City | FORT WALTON BEACH
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State | FL
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Zip | 32547-6645
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Country | US
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Telephone | 850-796-1368
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Fax | 850-796-2368
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Provider Business Mailing Address
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Address Line | 1032 MAR WALT DR SUITE 100
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City | FORT WALTON BEACH
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State | FL
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Zip | 32547-6645
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Country | US
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Telephone | 850-796-1368
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Fax | 850-796-2368
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. JOSEPH DANIEL SIEFKER
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Credential | MD
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Telephone | 850-796-1368
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | ME93776
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License Number State | FL
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