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Organization
4MD2 IN PATIENT PHYSICIAN SERVICES OF FORT WALTON BEACH LLC
Active
Organization
4MD2 IN PATIENT PHYSICIAN SERVICES OF FORT WALTON BEACH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GUY DUWANE HOOPER (PRESIDENT)
(205) 437-6098
Entity
Organization
Contact information
Practice address
1000 MAR WALT DR, SUITE 266, FORT WALTON BEACH, FL 32547-6708
(850) 863-7607
(205) 437-5998
Mailing address
PO BOX 88477, CHICAGO, IL 60680-1477
(205) 437-6098
(205) 437-5998
Taxonomy
Speciality
Code
Description
License number
State
208M00000X
Hospitalist Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2625352
UNITEDHEALTHCARE GROUP NO
FL
01
—
7532779
AETNA GROUP NO
FL
01
—
97919
GROUP BCBS NUMBER
FL
01
—
DE2953
GROUP RRMC NUMBER
FL
01
—
G017
BCBS GROUP PROVIDER NO
AL
Enumeration date
05/15/2006
Last updated
07/20/2007
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