# JACKIE W. WESTFALL D.O. LLC

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

## Provider details

- **NPI number:** 1740575158
- **Authorized official:** MR. JACKIE W. WESTFALL D.O. (PRESIDENT)
- **Authorized official phone:** (850) 682-5332

## Contact information

- **Practice address:** 322 RACETRACK RD NE, FORT WALTON BEACH, FL 32547-2546
- **Practice address phone:** (850) 682-5332
- **Practice address fax:** (850) 683-5333
- **Mailing address:** 322 RACETRACK RD NE, FORT WALTON BEACH, FL 32547-2546
- **Mailing address phone:** (850) 682-5332
- **Mailing address fax:** (850) 683-5333

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 302F00000X | Exclusive Provider Organization | OS5855 | FL | Yes |

## Other

- **Enumeration date:** 06/14/2011
- **Last updated:** 06/14/2011