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General NPI Number Information
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NPI Number | 1942690862
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Entity Type | Organization
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Legal Business Name | INGRID J RACHESKY M.D.
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Dates
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Enumeration Date | 01/30/2015
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Last Update Date | 01/30/2015
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Provider Practice Location Address
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Address Line | 2550 JENKS AVE
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City | PANAMA CITY
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State | FL
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Zip | 32405-4310
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Country | US
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Telephone | 850-769-1481
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Fax | 850-763-2435
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Provider Business Mailing Address
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Address Line | 2550 JENKS AVE
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City | PANAMA CITY
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State | FL
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Zip | 32405-4310
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Country | US
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Telephone | 850-769-1481
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Fax | 850-763-2435
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | SUSIE SMILEY
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Credential |
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Telephone | 850-769-1481
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | ME44063
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License Number State | FL
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