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General NPI Number Information
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NPI Number | 1811354129
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Entity Type | Organization
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Legal Business Name | THE DIABETES AND ENDOCRINE CENTER OF PENSACOLA LLC
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Dates
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Enumeration Date | 01/19/2016
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Last Update Date | 11/02/2016
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Provider Practice Location Address
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Address Line | 6160 N DAVIS HWY SUITE 10A
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City | PENSACOLA
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State | FL
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Zip | 32504-6994
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Country | US
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Telephone | 850-208-3848
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Fax | 850-208-3848
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Provider Business Mailing Address
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Address Line | 6160 N DAVIS HWY SUITE 10A
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City | PENSACOLA
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State | FL
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Zip | 32504-6994
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Country | US
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Telephone | 850-208-3848
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Fax | 850-476-0602
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | DR. VISHNU NARAYAN BEHARI
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Credential | M.D.
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Telephone | 850-208-3848
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 98582
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License Number State | FL
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