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General NPI Number Information
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NPI Number | 1962111005
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Entity Type | Organization
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Legal Business Name | OCHSNER 65 PLUS PENSACOLA - UNIVERSITY, L.L.C.
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Dates
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Enumeration Date | 11/17/2022
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Last Update Date | 11/17/2022
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Provider Practice Location Address
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Address Line | 1095 E NINE MILE RD UNIT 1
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City | PENSACOLA
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State | FL
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Zip | 32514-7485
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Country | US
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Telephone | 850-558-4665
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Fax |
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Provider Business Mailing Address
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Address Line | 1514 JEFFERSON HWY
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City | NEW ORLEANS
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State | LA
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Zip | 70121-2429
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | THOMAS DUNCAN
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Credential |
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Telephone | 850-558-4665
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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