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General NPI Number Information
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NPI Number | 1699841080
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Entity Type | Organization
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Legal Business Name | PARADIGM ANESTHESIA PA
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Dates
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Enumeration Date | 11/28/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1100 GULF BREEZE PKWY
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City | GULF BREEZE
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State | FL
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Zip | 32561-4836
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Country | US
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Telephone | 850-916-8500
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Fax |
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Provider Business Mailing Address
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Address Line | 6831 HALCYON PARK DR
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City | MONTGOMERY
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State | AL
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Zip | 36117-6972
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Country | US
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Telephone | 334-396-6930
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Fax | 334-396-6929
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Authorized Official
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Title or Position | OWNER
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Name | DR. GREGORY V HICKMAN
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Credential | M.D.
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Telephone | 205-985-7923
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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 | ME97173
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License Number State | FL
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