Organization · NPI-2

Abc Pediatrics Of Okaloosa

Pediatrics, Adolescent Medicine · Crestview, FL

NPI number1326418336

StatusActive

Last updated in NPPESOct 2, 2015

Details

NPI: 1326418336
Entity type: Organization (NPI-2)
Legal business name: Abc Pediatrics Of Okaloosa
Organization subpart: No
Enumeration date: Oct 2, 2015
Last updated: Oct 2, 2015

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
2080A0000X	Pediatrics, Adolescent Medicine	me70831	FL	Yes

Practice location

182 E. Redstone Ave
Suite B
Crestview, FL 32539

Phone 850-689-0900 · Fax 850-689-0912

Mailing address

2260 S Ferdon Blvd
Box 92
Crestview, FL 32536-8457

Phone 850-689-0900 · Fax 850-689-0912

Authorized official

Denise Mitchell
Office Manager
8506890900

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