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General NPI Number Information
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NPI Number | 1285679050
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Entity Type | Organization
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Legal Business Name | GULF COAST MEDICAL CENTER PRIMARY CARE LLC
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Dates
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Enumeration Date | 06/17/2006
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Last Update Date | 05/24/2011
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Provider Practice Location Address
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Address Line | 2202 STATE AVE STE. 207
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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 | 850-784-2645
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Fax | 850-784-2646
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Provider Business Mailing Address
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Address Line | 2202 STATE AVE STE. 207
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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 | 850-784-2645
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Fax | 850-784-2646
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Authorized Official
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Title or Position | VP
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Name | MICKEY PICKLER
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Credential |
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Telephone | 850-229-8288
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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