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Organization
COASTAL ORTHOPEDIC
Active
Organization
COASTAL ORTHOPEDIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE GLENN (OFFICE MANAGER)
(850) 678-2678
Entity
Organization
Contact information
Practice address
99 BAHIA VISTA DR, NICEVILLE, FL 32578-3617
(850) 678-2678
Mailing address
99 BAHIA VISTA DR, NICEVILLE, FL 32578-3617
(850) 678-2678
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
ME0063572
FL
Other
Enumeration date
06/28/2006
Last updated
12/01/2010
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