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General NPI Number Information
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NPI Number | 1265992200
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Entity Type | Organization
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Legal Business Name | GULF COAST INFECTIOUS DISEASE
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Dates
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Enumeration Date | 03/25/2019
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 2120 E JOHNSON AVE STE 105
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City | PENSACOLA
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State | FL
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Zip | 32514-6091
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Country | US
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Telephone | 850-549-4755
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Fax | 850-549-4760
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Provider Business Mailing Address
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Address Line | 2120 E JOHNSON AVE STE 105
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City | PENSACOLA
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State | FL
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Zip | 32514-6091
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Country | US
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Telephone | 850-549-4755
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Fax | 850-549-4760
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. AMANDA MARIE ALVARADO
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Credential |
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Telephone | 850-549-4755
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number |
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License Number State |
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