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General NPI Number Information
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NPI Number | 1841569357
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Entity Type | Organization
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Legal Business Name | CHILD NEUROLOGY CENTER OF NW FL PA
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Dates
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Enumeration Date | 12/29/2011
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Last Update Date | 12/29/2011
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Provider Practice Location Address
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Address Line | 400 GULF BREEZE PKWY SUITE 202
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City | GULF BREEZE
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State | FL
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Zip | 32561-4495
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Country | US
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Telephone | 850-932-5055
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Fax | 850-432-1401
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Provider Business Mailing Address
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Address Line | PO BOX 280
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City | GULF BREEZE
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State | FL
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Zip | 32562-0280
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Country | US
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Telephone | 850-932-5055
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Fax | 850-916-9331
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Authorized Official
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Title or Position | PROVIDER
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Name | MR. DAVID SUHRBIER
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Credential | D.O.
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Telephone | 850-932-5055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0402X
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Taxonomy Name | Neurology with Special Qualifications in Child Neurology Physician
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License Number |
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License Number State |
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