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General NPI Number Information
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NPI Number | 1700119443
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Entity Type | Organization
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Legal Business Name | BLUEWATER ORTHOPEDICS, P.A.
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Dates
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Enumeration Date | 09/14/2009
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Last Update Date | 03/02/2017
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Provider Practice Location Address
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Address Line | 120 E REDSTONE AVE SUITE B
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City | CRESTVIEW
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State | FL
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Zip | 32539-5370
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Country | US
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Telephone | 850-398-8600
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Fax | 850-897-1520
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Provider Business Mailing Address
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Address Line | 1950 BLUEWATER BLVD STE 100
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City | NICEVILLE
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State | FL
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Zip | 32578-3888
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Country | US
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Telephone | 850-897-8081
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Fax | 850-897-1520
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. THOMAS FOX
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Credential | M.D.
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Telephone | 850-897-8081
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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 | 601421
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License Number State | FL
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