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General NPI Number Information
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NPI Number | 1568375541
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Entity Type | Organization
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Legal Business Name | EMERALD COAST SURGICAL ASSOCIATES, LLC
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Dates
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Enumeration Date | 09/23/2026
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Last Update Date | 09/23/2026
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Provider Practice Location Address
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Address Line | 907 MAR WALT DR STE 2011
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City | FORT WALTON BEACH
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State | FL
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Zip | 32547-6756
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Country | US
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Telephone | 850-794-4572
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Fax | 850-794-4570
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Provider Business Mailing Address
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Address Line | 907 MAR WALT DR STE 2011
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City | FORT WALTON BEACH
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State | FL
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Zip | 32547-6756
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Country | US
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Telephone | 850-794-4572
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Fax | 850-794-4570
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Authorized Official
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Title or Position | OWNER
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Name | MATTHEW JOHNSON
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Credential | MD
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Telephone | 702-719-9059
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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