MEDICARE: ENT ASSOCIATES OF N.W. FLORIDA, PA

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	207Y00000X	Otolaryngology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235106733
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENT ASSOCIATES OF N.W. FLORIDA, PA

Provider Business Mailing Address
First Line	:	4616 N DAVIS HWY
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32503-2337
Country	:	US
Telephone Number	:	850-484-0520
Fax Number	:	850-484-9936

Provider Business Practice Location Address
First Line	:	4616 N DAVIS HWY
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32503-2337
Country	:	US
Telephone Number	:	850-484-8520
Fax Number	:	850-484-9936

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. WILLIAM BUREN CLARK
Credential	:	M.D.
Telephone Number	:	850-484-0520

Provider Enumeration Date	:	03/02/2006
Last Update Date	:	09/17/2012

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