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General NPI Number Information
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NPI Number | 1891763108
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Entity Type | Organization
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Legal Business Name | EMERALD COAST RADIATION ONCOLOGY
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Dates
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Enumeration Date | 03/10/2006
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Last Update Date | 02/05/2010
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Provider Practice Location Address
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Address Line | 7720 US HIGHWAY 98 W. SUITE 140
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City | DESTIN
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State | FL
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Zip | 32550-7230
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Country | US
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Telephone | 850-622-0873
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Fax | 850-622-1912
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Provider Business Mailing Address
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Address Line | PO BOX 18490
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City | PENSACOLA
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State | FL
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Zip | 32523-8490
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Country | US
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Telephone | 850-622-0873
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Fax | 850-622-1912
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Authorized Official
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Title or Position | CFO/SECRETARY/TREASURER
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Name | MR. BUDDY ELMORE
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Credential | CFO
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Telephone | 850-416-7638
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number |
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License Number State |
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