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General NPI Number Information
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NPI Number | 1720017882
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Entity Type | Organization
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Legal Business Name | EMERALD COAST INFECTIOUS DISEASES MEDICAL GROUP, P.A.
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Dates
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Enumeration Date | 07/01/2006
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Last Update Date | 01/27/2026
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Provider Practice Location Address
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Address Line | 917 MAR WALT DR
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City | FORT WALTON BEACH
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State | FL
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Zip | 32547-6651
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Country | US
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Telephone | 850-862-3979
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Fax |
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Provider Business Mailing Address
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Address Line | 917 MAR WALT DR
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City | FORT WALTON BEACH
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State | FL
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Zip | 32547-6651
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Country | US
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Telephone | 850-862-3979
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Fax | 850-862-0605
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Authorized Official
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Title or Position | CEO
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Name | ERIC SQUATRITO
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Credential |
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Telephone | 850-786-2270
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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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 | 207RA0201X
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Taxonomy Name | Allergy & Immunology (Internal Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number |
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License Number State |
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