# VIVID PATHOLOGY PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1225293707
- **Authorized official:** DR. CHARLES E FARMER MD (PRESIDENT)
- **Authorized official phone:** (850) 416-6894

## Contact information

- **Practice address:** 5151 N 9TH AVE, PENSACOLA, FL 32504-8721
- **Practice address phone:** (850) 416-6894
- **Practice address fax:** (850) 416-5487
- **Mailing address:** 5149 N 9TH AVE STE 122, PENSACOLA, FL 32504-8779
- **Mailing address phone:** (850) 416-2469
- **Mailing address fax:** (843) 664-4308

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207ZP0102X | Anatomic Pathology & Clinical Pathology Physician | — | FL | Yes |
| 207ZP0105X | Clinical Pathology/Laboratory Medicine Physician | — | FL | — |

## Other

- **Enumeration date:** 07/23/2008
- **Last updated:** 02/22/2018