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General NPI Number Information
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NPI Number | 1689330854
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Entity Type | Organization
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Legal Business Name | GULF COAST MOBILE MEDICAL CARE LLC
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Dates
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Enumeration Date | 11/12/2021
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Last Update Date | 02/23/2023
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Provider Practice Location Address
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Address Line | 471 FORT PICKENS RD
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City | PENSACOLA BEACH
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State | FL
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Zip | 32561-2013
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Country | US
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Telephone | 850-462-3131
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Fax | 877-370-4373
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Provider Business Mailing Address
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Address Line | 471 FORT PICKENS RD
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City | GULF BREEZE
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State | FL
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Zip | 32561-2013
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | JAKE WALLSTEDT
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Credential |
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Telephone | 615-517-6009
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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