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General NPI Number Information
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NPI Number | 1942561204
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Entity Type | Organization
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Legal Business Name | PHILLIP H NUNNERY MD PA
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Dates
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Enumeration Date | 06/04/2012
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Last Update Date | 09/27/2016
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Provider Practice Location Address
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Address Line | 1936 JENKS AVENUE
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City | PANAMA CITY
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State | FL
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Zip | 32405
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Country | US
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Telephone | 850-763-5959
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Fax | 850-785-0574
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Provider Business Mailing Address
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Address Line | 1936 JENKS AVENUE
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City | PANAMA CITY
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State | FL
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Zip | 32405
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Country | US
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Telephone | 850-763-5959
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Fax | 850-785-0574
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. BRENDA B NUNNERY
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Credential |
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Telephone | 850-763-5959
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | ME36299
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License Number State | FL
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