MEDICARE: SEA BREEZE FAMILY PRACTICE 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	173000000X	Legal Medicine	9501032	NC

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	:	1548222037
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEA BREEZE FAMILY PRACTICE P A

Provider Business Mailing Address
First Line	:	3004 BRIDGES ST
Second Line	:
City	:	MOREHEAD CITY
State	:	NC
Zip	:	28557-3330
Country	:	US
Telephone Number	:	252-727-4933
Fax Number	:	252-727-4936

Provider Business Practice Location Address
First Line	:	3004 BRIDGES ST
Second Line	:
City	:	MOREHEAD CITY
State	:	NC
Zip	:	28557-3330
Country	:	US
Telephone Number	:	252-727-4933
Fax Number	:	252-727-4936

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOSEPH F NUTZ JR.
Credential	:	M.D.
Telephone Number	:	252-727-4933

Provider Enumeration Date	:	04/03/2006
Last Update Date	:	02/06/2013

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Directions to “SEA BREEZE FAMILY PRACTICE P A ” Practice Location

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