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General NPI Number Information
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NPI Number | 1316184765
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Entity Type | Organization
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Legal Business Name | HOSPITALISTS AT FORT WALTON BEACH MEDICAL CENTER. LLC
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Dates
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Enumeration Date | 01/07/2009
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Last Update Date | 01/07/2009
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Provider Practice Location Address
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Address Line | 1000 MAR WALT DR
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City | FORT WALTON BEACH
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State | FL
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Zip | 32547-6708
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Country | US
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Telephone | 850-315-4249
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Fax | 866-958-1809
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Provider Business Mailing Address
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Address Line | 1000 MARWALT DRVIE
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City | FORT WALTON BEACH
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State | FL
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Zip | 32547-1000
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Country | US
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Telephone | 850-315-4249
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Fax | 866-958-1809
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICKEY PICKLER
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Credential |
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Telephone | 850-523-2117
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number |
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License Number State |
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