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Organization
CHILD NEUROLOGY CENTER OF NORTHWEST FLORIDA PA
Active
Organization
CHILD NEUROLOGY CENTER OF NORTHWEST FLORIDA PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES BEN RENFROE M.D. (OWNER)
(850) 932-5055
Entity
Organization
Contact information
Practice address
400 GULF BREEZE PKWY, SUITE 300, GULF BREEZE, FL 32561-4495
(850) 932-5055
(850) 932-1401
Mailing address
PO BOX 280, GULF BREEZE, FL 32562-0280
(850) 932-5055
(850) 932-1401
Taxonomy
Speciality
Code
Description
License number
State
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
—
—
208D00000X
General Practice Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
257889100
—
FL
05
—
529918930
—
AL
Enumeration date
11/07/2005
Last updated
01/20/2025
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