MEDICARE: WHITE-WILSON MEDICAL CENTER, P.A.

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	208000000X	Pediatrics Physician

General Provider Information

NPI Number	:	1184761538
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHITE-WILSON MEDICAL CENTER, P.A.

Provider Business Mailing Address
First Line	:	1005 MAR WALT DR
Second Line	:	BUSINESS OFFICE
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32547-6707
Country	:	US
Telephone Number	:	850-863-8105
Fax Number	:	850-863-8548

Provider Business Practice Location Address
First Line	:	990 AIRPORT RD
Second Line	:	PEDIATRIC DEPARTMENT
City	:	DESTIN
State	:	FL
Zip	:	32541-2820
Country	:	US
Telephone Number	:	850-837-3848
Fax Number	:	850-654-9581

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DOUGLAS W RIGBY
Credential	:	M.D.
Telephone Number	:	850-863-8131

Provider Enumeration Date	:	02/01/2007
Last Update Date	:	08/22/2020

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