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General NPI Number Information
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NPI Number | 1760738611
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Entity Type | Organization
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Legal Business Name | VIVID PATHOLOGY PA
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Dates
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Enumeration Date | 07/30/2012
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Last Update Date | 02/22/2018
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Provider Practice Location Address
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Address Line | 5151 N 9TH AVE
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City | PENSACOLA
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State | FL
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Zip | 32504-8721
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Country | US
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Telephone | 850-416-6484
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Fax | 850-416-7524
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Provider Business Mailing Address
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Address Line | 5149 N 9TH AVE
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City | PENSACOLA
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State | FL
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Zip | 32504-8756
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Country | US
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Telephone | 850-416-6484
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Fax | 850-416-7524
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHARLES E FARMER
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Credential | MD
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Telephone | 850-416-6484
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZC0500X
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Taxonomy Name | Cytopathology 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 | 207ZD0900X
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Taxonomy Name | Dermatopathology (Pathology) 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 | 207ZH0000X
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Taxonomy Name | Hematology (Pathology) Physician
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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 | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number |
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License Number State |
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