=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386042703
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | QUALITY PRIMARY CARE PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/17/2014
-----------------------------------------------------
Last Update Date | 06/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 514 MARY ESTHER CUT OFF NW
-----------------------------------------------------
City | FORT WALTON BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32548-4025
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-466-3399
-----------------------------------------------------
Fax | 850-226-6712
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 514 MARY ESTHER CUT OFF NW
-----------------------------------------------------
City | FORT WALTON BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32548-4025
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-466-3399
-----------------------------------------------------
Fax | 850-226-6712
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTOR
-----------------------------------------------------
Name | DR. NARENDRA KUMAR GOWDA
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 850-466-3399
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------