Organization · NPI-2

Emerald Coast Pulmonology, PA

Internal Medicine, Pulmonary Disease · Crestview, FL

NPI number1114013018
StatusActive
Last updated in NPPESMar 18, 2011

Details

NPI
1114013018
Entity type
Organization (NPI-2)
Legal business name
Emerald Coast Pulmonology, PA
Organization subpart
No
Enumeration date
Oct 5, 2006
Last updated
Mar 18, 2011

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207RP1001X Internal Medicine, Pulmonary DiseaseME63871FLYes
207RC0200X Internal Medicine, Critical Care MedicineME63871FL

Practice location

502 E Hickory Ave
Crestview, FL 32536-2742

Phone 850-423-1311 · Fax 850-423-1313

Mailing address

502 E Hickory Ave
Crestview, FL 32536-2742

Phone 850-423-1311 · Fax 850-423-1313

Authorized official

Laurie Koszuta
Director
8504231311

Is something wrong?

This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.

Other Internal Medicine, Pulmonary Disease providers in Crestview, FL