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General NPI Number Information
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NPI Number | 1649425877
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Entity Type | Organization
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Legal Business Name | DESTIN PRIMARY CARE CENTER
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Dates
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Enumeration Date | 12/02/2008
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Last Update Date | 12/02/2008
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Provider Practice Location Address
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Address Line | 36008 EMERALD COAST PKWY SUITE A-102
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City | DESTIN
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State | FL
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Zip | 32541-4792
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Country | US
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Telephone | 850-654-0997
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Fax | 850-654-2631
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Provider Business Mailing Address
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Address Line | 36008 EMERALD COAST PKWY SUITE A-102
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City | DESTIN
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State | FL
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Zip | 32541-4792
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Country | US
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Telephone | 850-654-0997
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Fax | 850-654-2631
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Authorized Official
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Title or Position | OWNER
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Name | DR. DAVID WILLIS WEBB
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Credential | M.D.
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Telephone | 850-654-0997
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MEOO16608
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License Number State | FL
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