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General NPI Number Information
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NPI Number | 1437601648
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Entity Type | Organization
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Legal Business Name | PANAMA CITY NEUROSURGERY PA
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Dates
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Enumeration Date | 11/04/2016
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Last Update Date | 11/05/2024
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Provider Practice Location Address
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Address Line | 15 DOCTORS DR
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City | PANAMA CITY
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State | FL
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Zip | 32405-4520
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Country | US
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Telephone | 508-392-0020
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Fax | 850-392-7897
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Provider Business Mailing Address
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Address Line | 15 DOCTORS DR
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City | PANAMA CITY
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State | FL
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Zip | 32405-4520
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Country | US
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Telephone | 850-392-0020
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Fax | 850-392-7897
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Authorized Official
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Title or Position | PROVIDER/OWNER
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Name | HEATHER ANN HEDSTROM
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Credential | MD
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Telephone | 850-392-0020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | ME125560
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License Number State | FL
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