# EMERALD COAST BONE DENSITOMETRY

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

## Provider details

- **NPI number:** 1407878408
- **Authorized official:** MICKI GLENN (OFFICE MANAGER)
- **Authorized official phone:** (850) 864-2663

## Contact information

- **Practice address:** 417 RACETRACK RD NW \# B, FORT WALTON BEACH, FL 32547-4612
- **Practice address phone:** (850) 864-2663
- **Mailing address:** 417 RACETRACK RD NW \# B, FORT WALTON BEACH, FL 32547-4612
- **Mailing address phone:** (850) 864-2663

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2085B0100X | Body Imaging Physician | ME0063572 | FL | Yes |

## Other

- **Enumeration date:** 07/25/2006
- **Last updated:** 10/11/2007