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General NPI Number Information
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NPI Number | 1437374212
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Entity Type | Organization
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Legal Business Name | TWIN CITIES PRIMARY CARE- DESTIN LLC
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Dates
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Enumeration Date | 04/16/2007
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Last Update Date | 02/17/2010
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Provider Practice Location Address
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Address Line | 12272 EMERALD COAST PARKWAY
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City | DESTIN
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State | FL
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Zip | 32550
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Country | US
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Telephone | 850-269-0662
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Fax | 850-269-0745
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Provider Business Mailing Address
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Address Line | 12272 EMERALD COAST PARKWAY
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City | DESTIN
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State | FL
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Zip | 32550
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Country | US
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Telephone | 850-269-0662
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Fax | 850-269-0745
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MR. 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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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