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General NPI Number Information
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NPI Number | 1679589428
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Entity Type | Organization
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Legal Business Name | GULF COAST PHYSICIAN PARTNERS
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Dates
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Enumeration Date | 08/01/2006
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Last Update Date | 05/16/2025
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Provider Practice Location Address
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Address Line | 5907 BERRYHILL RD
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City | MILTON
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State | FL
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Zip | 32570-8278
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Country | US
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Telephone | 850-623-9787
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Fax | 850-626-7512
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Provider Business Mailing Address
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Address Line | 5907 BERRYHILL RD
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City | MILTON
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State | FL
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Zip | 32570-8278
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Country | US
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Telephone | 850-623-9787
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Fax | 850-626-7512
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOSEPH FOUNTAIN
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Credential | DO
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Telephone | 850-623-9787
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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