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General NPI Number Information
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NPI Number | 1407892938
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Entity Type | Organization
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Legal Business Name | SOUTHERN ORTHOPEDIC SPECIALISTS PA
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Dates
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Enumeration Date | 06/22/2006
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Last Update Date | 12/01/2025
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Provider Practice Location Address
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Address Line | 1827 HARRISON AVE
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City | PANAMA CITY
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State | FL
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Zip | 32405-7605
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Country | US
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Telephone | 850-785-4344
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Fax | 850-785-6568
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Provider Business Mailing Address
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Address Line | 1827 HARRISON AVE
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City | PANAMA CITY
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State | FL
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Zip | 32405-7605
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Country | US
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Telephone | 850-785-4344
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Fax | 850-785-6568
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Authorized Official
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Title or Position | CEO
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Name | DELFORD GREGGS JR.
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Credential |
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Telephone | 850-785-4344
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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