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General NPI Number Information
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NPI Number | 1699868711
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Entity Type | Organization
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Legal Business Name | GORDON T COUCH MD
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 05/09/2013
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Provider Practice Location Address
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Address Line | 4900 BAYOU BLVD STE 104
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City | PENSACOLA
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State | FL
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Zip | 32503-2533
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Country | US
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Telephone | 850-477-2330
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Fax | 850-484-8733
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Provider Business Mailing Address
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Address Line | 4900 BAYOU BLVD STE 104
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City | PENSACOLA
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State | FL
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Zip | 32503-2533
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Country | US
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Telephone | 850-477-2330
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Fax | 850-484-8733
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Authorized Official
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Title or Position | PHYSICIAN
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Name | MR. GORDON THAMES COUCH
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Credential | MD
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Telephone | 850-477-2330
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | ME0013562
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License Number State | FL
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