MEDICARE: CAMMACK CLINIC 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	207R00000X	Internal Medicine Physician	0069924	FL

General Provider Information

NPI Number	:	1275858870
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAMMACK CLINIC PA

Provider Business Mailing Address
First Line	:	7552 NAVARRE PKWY UNIT 45
Second Line	:
City	:	NAVARRE
State	:	FL
Zip	:	32566-7309
Country	:	US
Telephone Number	:	850-936-9665
Fax Number	:

Provider Business Practice Location Address
First Line	:	7552 NAVARRE PKWY UNIT 45
Second Line	:
City	:	NAVARRE
State	:	FL
Zip	:	32566-7309
Country	:	US
Telephone Number	:	850-936-9665
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ANTHONY JEROME CAMMACK
Credential	:	M.D.
Telephone Number	:	850-936-9665

Provider Enumeration Date	:	04/07/2010
Last Update Date	:	04/07/2010

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