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General NPI Number Information
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NPI Number | 1831461946
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Entity Type | Organization
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Legal Business Name | MILEPRO LLC
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Dates
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Enumeration Date | 02/04/2012
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Last Update Date | 02/04/2012
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Provider Practice Location Address
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Address Line | 653 W 23RD ST STE 294
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City | PANAMA CITY
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State | FL
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Zip | 32405-3922
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Country | US
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Telephone | 850-819-5614
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Fax |
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Provider Business Mailing Address
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Address Line | 653 W 23RD ST STE 294
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City | PANAMA CITY
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State | FL
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Zip | 32405-3922
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Country | US
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Telephone | 850-819-5614
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MR. ERIC LLOYD METZGER
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Credential | ARNP/FNP-C
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Telephone | 850-819-5614
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | ARNP3176072
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License Number State | FL
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