# KETCHUM WOOD & BURGERT CHARTERED DRS KETCHUM WOOD & BURGERT

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** KETCHUM WOOD & BURGERT CHARTERED DRS KETCHUM WOOD & BURGERT
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1821060898
- **Legal business name:** KETCHUM WOOD & BURGERT CHARTERED DRS KETCHUM WOOD & BURGERT
- **Authorized official:** MRS. ANGELA FUQUA (ADMINISTRATOR)
- **Authorized official phone:** (850) 219-7603

## Contact information

- **Practice address:** 1899 EIDER CT, TALLAHASSEE, FL 32308-4537
- **Practice address phone:** (850) 878-5143
- **Practice address fax:** (850) 942-6622
- **Mailing address:** 1899 EIDER CT, TALLAHASSEE, FL 32308-4537
- **Mailing address phone:** (850) 878-5143
- **Mailing address fax:** (850) 942-6622

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207ZP0102X | Anatomic Pathology & Clinical Pathology Physician | 800000042 | FL | Yes |

## Other

- **Enumeration date:** 02/03/2006
- **Last updated:** 05/15/2020