Organization · NPI-2

Okaloosa Cardiology P A

Internal Medicine, Cardiovascular Disease · Crestview, FL

NPI number1144270240

StatusActive

Last updated in NPPESAug 25, 2011

Details

NPI: 1144270240
Entity type: Organization (NPI-2)
Legal business name: Okaloosa Cardiology P A
Organization subpart: No
Enumeration date: May 11, 2006
Last updated: Aug 25, 2011

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
207RC0000X	Internal Medicine, Cardiovascular Disease	–	–	Yes
2086S0129X		–	–

Practice location

129 E Redstone Ave
Suite A
Crestview, FL 32539-5350

Phone 850-682-7212

Mailing address

129 E Redstone Ave
Suite A
Crestview, FL 32539-5350

Phone 850-682-7212

Authorized official

Donna M Gibson
Billing Manager
8506827212

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