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General NPI Number Information
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NPI Number | 1457150179
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Entity Type | Organization
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Legal Business Name | EMERALD COAST INFECTIOUS DISEASES MEDICAL GROUP, P.A.
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Dates
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Enumeration Date | 03/13/2025
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Last Update Date | 03/13/2025
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Provider Practice Location Address
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Address Line | 1710 LISENBY AVE
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City | PANAMA CITY
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State | FL
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Zip | 32405-3730
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Country | US
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Telephone | 850-807-4420
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Fax |
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Provider Business Mailing Address
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Address Line | 917 MAR WALT DR
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City | FORT WALTON BEACH
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State | FL
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Zip | 32547-6651
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Country | US
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Telephone | 850-862-3979
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Fax |
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Authorized Official
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Title or Position | ASSISTANT PRACTICE MANAGER
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Name | KELLEY GEAR
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Credential |
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Telephone | 850-862-3979
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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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 | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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