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NPI Code Detail

MEDICARE: PHILLIP HARDY NUNNERY M D

MEDICARE:   PHILLIP HARDY NUNNERY  M D
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
1208200000XPlastic Surgery PhysicianME36299FL

Other Identifiers

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

General Provider Information

NPI Number : 1588747471
Entity Type Code : Individual
Provider Name (Legal Business Name) : PHILLIP HARDY NUNNERY M D
Provider Business Mailing Address
First Line : 1936 JENKS AVE
Second Line :
City : PANAMA CITY
State : FL
Zip : 32405-4528
Country : US
Telephone Number : 850-763-5959
Fax Number : 850-785-0574
Provider Business Practice Location Address
First Line : 1936 JENKS AVE
Second Line :
City : PANAMA CITY
State : FL
Zip : 32405-4528
Country : US
Telephone Number : 850-763-5959
Fax Number : 850-785-0574
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/23/2006
Last Update Date : 12/17/2020

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