Organization · NPI-2

Emerald Coast Urology, LLC

Urology · Crestview, FL

NPI number1033063268
StatusActive
Last updated in NPPESMay 18, 2026

Details

NPI
1033063268
Entity type
Organization (NPI-2)
Legal business name
Emerald Coast Urology, LLC
Organization subpart
No
Enumeration date
Feb 24, 2026
Certification date
May 18, 2026
Last updated
May 18, 2026

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
208800000X Urology––Yes

Practice location

435 Brookmeade Dr
Crestview, FL 32539-7304

Phone 850-605-0550 · Fax 850-605-0440

Mailing address

Po Box 1027
Niceville, FL 32588-1027

Phone 850-605-0550 · Fax 850-605-0440

Authorized official

Joseph William Pugh
Owner
9044727441

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