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General NPI Number Information
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NPI Number | 1548578693
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Entity Type | Organization
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Legal Business Name | PANAMA CITY PSYCHIATRIC CARE
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Dates
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Enumeration Date | 09/22/2010
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Last Update Date | 04/01/2015
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Provider Practice Location Address
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Address Line | 217 FOREST PARK CIR
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City | PANAMA CITY
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State | FL
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Zip | 32405-4916
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Country | US
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Telephone | 850-348-6564
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Fax |
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Provider Business Mailing Address
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Address Line | 217 FOREST PARK CIR
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City | PANAMA CITY
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State | FL
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Zip | 32405-4916
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Country | US
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Telephone | 850-348-6564
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | GARY D GORMAN
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Credential | M.D.
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Telephone | 850-348-6564
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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