MEDICARE: DR. BRITTAIN F KULOW MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	ME86612	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7129491	OTHER		AETNA
2	71665	OTHER	FL	BLUE CROSS

General Provider Information

NPI Number	:	1013932698
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRITTAIN F KULOW MD

Provider Business Mailing Address
First Line	:	1112 HOSPITAL RD STE A
Second Line	:
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32547-6742
Country	:	US
Telephone Number	:	850-314-7546
Fax Number	:	850-314-7542

Provider Business Practice Location Address
First Line	:	1112 HOSPITAL RD STE A
Second Line	:
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32547-6742
Country	:	US
Telephone Number	:	850-314-7546
Fax Number	:	850-314-7542

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	07/08/2007

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