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General NPI Number Information
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NPI Number | 1881674257
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Entity Type | Organization
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Legal Business Name | FIRST PHYSICIANS GROUP PA
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Dates
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Enumeration Date | 01/20/2006
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Last Update Date | 10/12/2009
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Provider Practice Location Address
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Address Line | 3802 HIGHWAY 90
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City | PACE
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State | FL
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Zip | 32571-1014
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Country | US
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Telephone | 850-994-5660
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Fax | 850-994-5841
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Provider Business Mailing Address
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Address Line | PO BOX 18868
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City | PENSACOLA
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State | FL
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Zip | 32523-8868
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Country | US
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Telephone | 850-994-5660
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Fax | 859-994-5841
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Authorized Official
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Title or Position | CREDENTIALING
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Name | KYLIE BAISDEN
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Credential |
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Telephone | 850-994-5660
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State | FL
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