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General NPI Number Information
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NPI Number | 1922031343
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Entity Type | Organization
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Legal Business Name | SURGICAL ASSOCIATES OF NORTHWEST FL PA
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Dates
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Enumeration Date | 07/09/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 740 HARRISON AVE
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City | PANAMA CITY
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State | FL
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Zip | 32401-2524
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Country | US
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Telephone | 850-785-3232
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Fax | 850-747-8648
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Provider Business Mailing Address
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Address Line | 740 HARRISON AVE
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City | PANAMA CITY
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State | FL
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Zip | 32401-2524
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Country | US
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Telephone | 850-785-3232
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Fax | 850-747-8648
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RICHARD BOULWARE WILSON
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Credential | M.D.
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Telephone | 850-785-3232
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | NOT APPLICABLE
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License Number State | FL
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