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General NPI Number Information
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NPI Number | 1952825259
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Entity Type | Organization
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Legal Business Name | SUSAN CULVERHOUSE, MD PA
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Dates
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Enumeration Date | 07/28/2017
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Last Update Date | 07/28/2017
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Provider Practice Location Address
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Address Line | 801 E 6TH ST STE 201
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City | PANAMA CITY
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State | FL
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Zip | 32401-3667
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Country | US
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Telephone | 850-763-8680
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Fax |
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Provider Business Mailing Address
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Address Line | 707 E CERVANTES ST, SUITE B #298
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City | PENSACOLA
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State | FL
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Zip | 32501
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Country | US
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Telephone | 407-272-4232
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Fax |
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Authorized Official
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Title or Position | MD / PRESIDENT
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Name | SUSAN HOWARD CULVERHOUSE
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Credential | MD
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Telephone | 813-784-3746
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | ME106708
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License Number State | FL
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